you know, kyle, you know hmo's are insulated from
being sued for malpratice, but you can remind them
that they are "not" insulated from being sued for
discrimination. i think they might just take time to
think about the possibility.

--- "Cleveland, Kyle E." <[log in to unmask]>
wrote:
> Thanks, Beth.  Yeah, I already approached my surgeon
> with that one and he
> said that he would only cut the bare minimum.  He's
> a really good "Joe", and
> I trust him on this one.  Laura had surgery about
> ten years back and he was
> the cutter.  I was really impressed with his bedside
> manner and suturing.
>
> I've been fighting with "peer review" already at the
> insurance co.  At best,
> these folks are LPNs, most don't have any formal
> medical education at all.
> The doc is as frustrated as I am about their
> reticence to have someone else
> close. He admits that a plastic surgeon could close
> better, even with no
> reconstruction.  They are pretty adamant about the
> whole thing--because "the
> book says it's not 'medically or psychologically
> necessary' for men to have
> reconstruction."  If it ain't in the "book", they
> ain't payin'--pure and
> simple.  Our benefits administrator said to me that
> I have to be careful
> when deciding whether to fight or stand-down as the
> carriers are becoming
> "hip" to all of the arguments.  She said that I've
> already become a
> statistical liability to the carrier, so I need to
> pick my battles
> carefully.  Still, the "breathing" angle is one I
> hadn't considered.
> Thanks!  I'll call my cutter today and run that past
> him.  Who knows?  Maybe
> he can plead the case that with my spastic CP, a
> second pair of experienced
> hands might be cheaper in the long haul.
>
> Kyle
>
>
> -----Original Message-----
> From: Elizabeth H. Thiers
> [mailto:[log in to unmask]]
> Sent: Monday, July 28, 2003 4:52 PM
> To: [log in to unmask]
> Subject: Re: Hey all
>
>
> You know, it may delay your surgery a bit but, you
> can ask for a plastic
> surgeon to close for you.  My friend did this when
> she had her bilateral
> mastectomy.  You can tell them you need all the
> muscles and soft fascia you
> can in order to breath properly.  (the pecs are an
> auxillary breathing
> muscle).
>
> I'd keep harrassing the insurance.
>
> beth t.


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