After several very frustrating conversations with my insurance company, I finally got them to approve a gap extension to allow me to get a breast prosthesis. I was almost in tears when they said no your insurance doesn't cover this and that. Not that we couldn't afford to pay out of pocket, I just wanted it to go smoothly. Plus by law, they need to pay for some portion of these services, just like they paid for the implant surgery.
Looking back, I think they thought I was lying on the phone to try and get some lingerie or something. I realize I changed my story a few times, first saying that I had a mastectomy back in Feb (which is true), and then saying that I had surgery a few weeks ago (also true), plus I couldn't remember any of the specific dates for the surgeries. I also was irritated that they insisted on speaking to my doctor- I was like I have the prescription, why isn't that enough? I was not sure that my surgeon would have time to talk to my insurance company, he's already done so much for me, I didn't want to annoy him more. I also insisted on speaking to the supervisor, because every person I talked to told me a different story- like oh yeah those are covered, or no that is out of network and you can't apply for a gap extension with your plan. Or oh, you need a prescription for the bras too. I was like WTF, and I broke down crying on the phone- all I want is to look normal, is that so hard? You paid for my $$$ reconstruction surgery without so much of a peep, and now your being all difficult for a couple hundred dollar piece of silicone and a few bras? Seriously?
I assumed they had access to my medical file, like the procedures I'd had- aka mastectomy, but now I realize that they didn't and they had to go on what I said over the phone. Finally I had my doctor's nurse call them and explain the situation. When the insurance company called me back it was like 180 degree difference, they were so nice and helpful, and assured me that I would be able to get the gap extension and that the out of network "boob supplier", Fittings Unlimited would be considered in-network and be covered in full.
Other than that, we're working on putting our house on the market, so we can build our dream home in North Liberty!!! We are so excited. Although we LOVE our current home, and will dearly miss all the plants we planted in the yard- this house just doesn't have alot of storage and it has no storm shelter. With all the thunderstorms, hail and tornadoes- we really want a true basement that is underground. The Realtor is coming tonight to look at our house- hopefully he'll be impressed, and it will sell quickly.
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