I Am Proactive!

Now that I am feeling my energy come back day by day, I've had a burst of what you might call proactivity (is that really a word?). I spent Friday afternoon on the Internet and phone, trying to find a support group for women who have had a mastectomy, and trying to clarify what benefits I am eligible for in the way of breast forms and special bras.

I located two support groups, first one at the hospital where I am treated, Memorial Sloan-Kettering on Thursdays, and then one sponsored by a group called SHARE, on Tuesdays. I called both because I couldn't reach either one at first, then found myself agreeing to go to two meetings this week,which is overkill. I know I don't want to belong to two groups, but I suppose I'll go and see. Somehow it's just like me to get into these awkward situations (go once and then not go back to one or both?).

The insurance question turned out to be both more complicated and more frustrating. First the United Health Care rep couldn't answer the benefits question because I didn't have "codes" for what they warmly call "Durable Medical Equipment, Subcategory Prothesis." So I had to call the hospital for the codes. No answer, of course (does anyone, anywhere who has information ever answer the phone?). Then when I finally got the codes today, I ran into a UHC rep on the phone who had no idea what to tell me -- she recommended I call their affiliated Cancer Resource Service, they'd know. So I go through all the stupefyingly boring questions (name, address, phone, date of birth, member ID number, etc. etc.) for the millionth time with the Cancer Resource Service, whose rep painstakingly registers me for the service before I get to ask the benefits question. Oh, he says, we don't handle that here, we just give medical advice...but the insurance rep should have those answers. Except she didn't.

Meanwhile, I would love to get something plausible to stuff the bra I already have until I'm healed enough to get fitted with the Durable Medical Device, Subcategory Prosthesis. But that turns out to be maddeningly complicated too. The UHC rep read aloud that I am allowed one bra and one prosthesis -- let me call it a breast form before I spit at someone -- and it must be, she read, "the most cost-effective one." How do I know which that is before I buy it? I asked. She was flustered and basically said she didn't know. So I called a boutique I found online (on Friday, when I was being proactive -- naturally I had to leave a message there too) that specializes in this sort of item -- it's tellingly named My Secret, which makes me feel like I'll be entering the store in a gray raincoat and emerging with a shameful item in a plain brown wrapper. You can buy both the silicone breast form and also a light foam one, the saleswoman told me, as long as you have two different prescriptions from the doctor.

Well, I have one presciption, and I'm not about to go to the trouble of getting another and buying two (they're $120-200 each) unless I hear for sure that two are covered under my insurance plan. So back to another UHC rep (after giving all my info a million and one times), who was brighter than the first one and actually asked someone there at the UHC store, or whatever it is. Now this rep insists that there was a bill passed in Congress that a post-mastectomy patient can have as many forms and bras covered as she wants, as long as you don't buy more than one a day, no prescription needed. So now I've gone from fuming at how limited the coverage is to doubting it could possibly be that generous. Really, they'll pay for 365 bras and forms as long as I purchase them on separate days? Do I believe that?

Sigh. Now I know why people complain about (private) insurance.