Hi Kyle,

    I would think you would need recontructive surgury - as don't you have spasms? You could seriously injure yourself if the incision and surrounding area aren't pieced together well. Have they taken your CP into account? I would get a another opinion - generally one is allowed 2nd and 3rd opinions - if all recommend reconstructive surgery then you have leverage. So perhaps a CP expert would be in order. 

                                     Trisha


> 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.