According to bloomberglaw.com, insurers across the nation are using the excuse that no true medical definition for breast implant illness currently exists, as a means of avoiding payment for injured women. Leaking breast implants have been found to potentially cause a number of illnesses, including:
- Memory loss;
- Swollen lymph nodes;
- Chronic sinus infections;
- Lung infections;
- Saliva and tear duct infections;
- Joint infections;
- Autoimmune disorders, and
- Blood clots.
Despite this, women who need to have the implants removed may face serious obstacles in the form of insurers refusing to pay for the procedure. Bloomberg notes that the cost of removing a breast implant can be as high as $8,000 without insurance. It’s important to know that if you or someone you know has been seriously injured as a result of a breast implant and are unable to pay your medical expenses, USClaims can provide financial support to cover bills and expenses related to a breast implant lawsuit in anticipation of a court judgment or settlement.
Explosion of Breast Implant Problems Beginning in the Second Half of 2017
According to medicalxpress.com, between 2008 and 2015 the FDA reported about 200 breast implant complaints per year—a mere fraction of the hundreds of thousands of implant surgeries performed annually. Then in 2017, literally thousands of breast implant problems flooded the FDA’s system, with more than 4,000 injury reports filed in the last half of 2017, and a whopping 8,000 in the first six months of 2018.
Many Insurers Refuse to Classify Removal of Breast Implants as Medically Necessary
Unless the implant leaks, causes severe, chronic pain in the breasts, or interrupt cancer screenings, many insurers will not classify removal of the implants as a medically necessary procedure. According to Diana Zuckerman, head of the National Center for Health Research, “Since breast implant illness isn’t recognized, it’s not included.” Women, desperate to have the implants removed after suffering from breast implant illness, have asked the FDA for help. Unfortunately, when it comes to insurance coverage, the agency has no power to force insurers to cover the procedure.
FDA Flags Two Breast Implant Manufacturers
What the FDA can—and has—done, however, is to hold a public meeting on the issue just this past March. The agency flagged two breast implant manufacturers—Mentor Worldwide LLC and Sientra Inc.—for failing to properly test the implants for safety and effectiveness following approval. Not all insurers are refusing to cover the removal of breast implants, although most will only do so if the removal surgery is medically necessary. Aetna considers removal of breast implants medically necessary if the patient “has a cancer of the immune system”.
Test to Determine Whether Implants Have Ruptured Also Denied Coverage
Not only are insurers refusing to cover removal of breast implants, many insurers will not even cover the cost of the test which determines whether an implant has ruptured. In a true Catch-22 situation, some insurers will cover removal of breast implants if there is a confirmed rupture—but most will not cover the MRI to determine whether the implant has ruptured. Further, silicone-filled implants often cause “silent” ruptures—little tears leaving few or no signs or symptoms because the silicone becomes trapped in surrounding tissues.
Plastic Surgeons Must Vouch for Patients’ Injuries and Symptoms
It can be easier to have the breast implants removed, or have other treatments covered by insurance when a plastic surgeon vouches for his or her patient, noting the specific injuries and symptoms related to the breast implants for the benefit of the insurer. To be clear, while physicians cannot tell insurers what they should and should not cover, when the physician clearly states a woman’s suffering related to breast implants, the patient may get that much closer to coverage. Many physicians say that while they use the “best” code to describe a woman’s illness (related to breast implants), the bill will often still get kicked back.
Cathryn Donaldson, a spokesperson for America’s Insurance Plans, says insurance coverage is based on medical need, specific plan, who will provide the treatment, where the treatment will take place and the circumstances for the treatment. Donaldson says if the treatment is clearly a medical necessity, it will generally be covered, but that women need to learn to build a better case for removal of leaky breast implants in order to avoid an insurance denial.
FDA Study Will Help Women Seeking Treatment
A study by the FDA will, of course, help women get the coverage they need, and plastic surgeons can also help by coming up with a more comprehensive diagnosis code. Surgeons who participate in the National Breast Implant Registry are able to track complications associated to breast implants; if a woman’s surgeon is a participant, it may also be easier to obtain treatment.
Helping Clients Involved in a Breast Implant Lawsuit Injury
Clients who have been injured as the result of a breast implant could find themselves with serious injuries and medical expenses, they may be unable to pay. These clients may also be unable to work because of the serious nature of the breast implant injuries. USClaims can help your clients pay both their medical expenses and their regular, day-to-day expenses related to a breast implant lawsuit in anticipation of a court judgment or settlement. Apply now or call us today at 1-877-USCLAIMS to learn more.