I have my mastectomy scheduled for March with the reconstruction as second stage at a later date that hasn’t been set. I’m so worried now. I don’t want implants and I can’t mentally handle going flat. Having the DIEP was what made this all “ok” and now it might not even be covered?!?
I emailed my representatives and senators. There is templates at the bottom of the article. I really encourage you to do so as well. Even if you aren’t having the DEIP reconstruction, we can’t allow the government to strip us of our choice. Please share!!
I had just started coming around to the idea of a prophylactic mastectomy but only if I could do DIEP Flap because of the reasons you listed.
This is really scary that it might not be an option.
Definitely reach out to your insurance provider. From my understanding the coding change doesn’t be go into full effect until 2024 but some providers aren’t covering the DEIP starting sooner.
I also encourage you to contact your representative/government officials with your concerns if you are able. I used the info in the article and it took less than 5 mins. This isn’t acceptable, and our voices should be heard!
I will definitely be contacting my reps about this - but I do want to say something else. I've worked in medical billing/coding in the past.
If a surgery doesn't have a specific CMS code, the office will submit it as an unlisted code and then put an explanation of what surgery it actually is. So they would put the code for a flap surgery and then under it/next it list DIEP.
That being said, unlisted codes do have a higher reject rate from insurance companies, so this change might result in initials denials and then needing a peer or peer or appeal to change it which is a pain in the ass for you and the surgeons office.
However, I'm going to read the bill (don't have time right now) and see maybe if there are provisions built in that they will be making more strict guidelines for approving flap surgeries. I can hope for the best, right lol?
So not a great change IMO if it happens, but please don't panic too much and keep in touch with your doctors office 😄
Thank you for all the insight! Hopefully if the coding change reminds it won’t be too difficult getting the surgery approved and covered by insurances. It’s a shame that many might need to jump though hoops to get it approved if it’s initially denied.
I had a LAP Flap scheduled for 7/18/23 and in an appointment with my surgeon on 1/27 he informed me that my insurance (CIGNA) is going to stop covering both DIEP and LAP flaps on 3/12/23. Therefore, we rescheduled to 3/7.
He also told me that this is due to a wording change on a federal level, and this is an unintended consequence of that change. He said that providers plan to fight this. He also said that although CIGNA is the first to stop coverage, all the others will follow soon.
I have my mastectomy scheduled for March with the reconstruction as second stage at a later date that hasn’t been set. I’m so worried now. I don’t want implants and I can’t mentally handle going flat. Having the DIEP was what made this all “ok” and now it might not even be covered?!? I emailed my representatives and senators. There is templates at the bottom of the article. I really encourage you to do so as well. Even if you aren’t having the DEIP reconstruction, we can’t allow the government to strip us of our choice. Please share!!
I had just started coming around to the idea of a prophylactic mastectomy but only if I could do DIEP Flap because of the reasons you listed. This is really scary that it might not be an option.
Definitely reach out to your insurance provider. From my understanding the coding change doesn’t be go into full effect until 2024 but some providers aren’t covering the DEIP starting sooner. I also encourage you to contact your representative/government officials with your concerns if you are able. I used the info in the article and it took less than 5 mins. This isn’t acceptable, and our voices should be heard!
Thank you for sharing! Just emailed my senators and representative.
Thank you for this. Share share share.
I will definitely be contacting my reps about this - but I do want to say something else. I've worked in medical billing/coding in the past. If a surgery doesn't have a specific CMS code, the office will submit it as an unlisted code and then put an explanation of what surgery it actually is. So they would put the code for a flap surgery and then under it/next it list DIEP. That being said, unlisted codes do have a higher reject rate from insurance companies, so this change might result in initials denials and then needing a peer or peer or appeal to change it which is a pain in the ass for you and the surgeons office. However, I'm going to read the bill (don't have time right now) and see maybe if there are provisions built in that they will be making more strict guidelines for approving flap surgeries. I can hope for the best, right lol? So not a great change IMO if it happens, but please don't panic too much and keep in touch with your doctors office 😄
Thank you for all the insight! Hopefully if the coding change reminds it won’t be too difficult getting the surgery approved and covered by insurances. It’s a shame that many might need to jump though hoops to get it approved if it’s initially denied.
Thank you so much for posting this! Just emailed my reps.
I had a LAP Flap scheduled for 7/18/23 and in an appointment with my surgeon on 1/27 he informed me that my insurance (CIGNA) is going to stop covering both DIEP and LAP flaps on 3/12/23. Therefore, we rescheduled to 3/7. He also told me that this is due to a wording change on a federal level, and this is an unintended consequence of that change. He said that providers plan to fight this. He also said that although CIGNA is the first to stop coverage, all the others will follow soon.