Newsline 2002 August – Breast Implants again in the News, Cosmetic Surgery and Insurance

Vol.1, No.3 – August 2002

Our Internet Newsletter

Greetings from Dr. Tobin

Welcome to our August email newsletter. This has been a very busy summer for all of us at the Facial Plastic & Cosmetic Surgical Center. In spite of the tumultuous economic times, people still feel that cosmetic surgery is important enough to make sacrifices in other area of their life to allow them to have the procedures they are seeking. I believe that this is quite a testimony to the fact that the service we perform is making real and important changes in our patients’ lives.

Breast Implants again in the news

In the NEWS section of our website, we posted an article by the FDA advisory committee dealing with cosmetic surgery. Based on some data presented by the implant manufacturers, they reported that in five years, 25% of patients studies required secondary surgery for problems related to their implants. We found this quite shocking since our own recent study had pegged the figure at about 10%. You can read about both the FDA study and our own by checking out the two lead articles in the NEWS section of our home page: www.newlook.org.

Cosmetic Surgery and Insurance

We get a lot of questions about this subject and I just wanted to cover it briefly. First of all, please remember that insurance is a contract between you and your company and we as physicians have no control over the terms of the policy. Nearly all policies have some general exclusion related to cosmetic surgery. While there are a few exceptions, they are quite rare.

Questions generally arise when there may be a functional component to the surgery. For example, breast reconstruction after mastectomy obviously is cosmetic, but it is also clearly reconstructive, since it is restoring normal form rather than improving it. Many cases of breast reduction are covered because the primary motivation for surgery is to relieve pain.

In the past, insurance companies were far more permissive in their interpretation of what was functional and what was cosmetic. Unfortunately, this often led to abuse. Many cosmetic nose operations were passed off as functional because of alleged breathing difficulty. Granted, often there was a dual purpose for the surgery, but there is no escaping the fact that it was abused.

Today, insurance companies are far more restrictive and generally will seek convincing evidence of the functional nature of the problem. Often the companies go too far and many patients are being unfairly denied coverage.

What can you do? First of all, read the policy carefully. Secondly, be willing to stand up for your rights. If you believe you are being unfairly denied, insist of communicating with someone with higher authority. Persistence often does pay off. Your surgeon or primary care physician can often be of help by confirming the functional nature of your problem.

What you can’t do! Please don’t ask your surgeon or physician to lie or make false statements in your behalf. First of all, it is a crime to do so, and many doctors have been prosecuted for just such an action. Even more important, if you expect your doctor to lie to an insurance company, how can you expect him or her to be honest with you? While we certainly want to help you obtain all the possible benefits of your policy, it is even more important that we earn your trust in our complete honesty.

On the Lecture Circuit

By the time you read this, I will have returned from a major facial cosmetic surgery seminar in Newport Beach, CA. As you might imagine, I have been quite busy preparing the seven talks I was asked to give. They covered a broad variety of topics including our concept of the secondary tuck following face lift surgery, the brow suspension procedure and our renewed interest in microdroplet silicone injection treatment as a soft tissue filler. All of these topics are covered on our web site if you are interested. If you have trouble finding them, try the search engine near the top of the home page.

I was also asked to give several talks about our use of the Internet. Our website has certainly become one of the more popular sources of information about cosmetic surgery on the web. We receive from 6,000 to 9,000 hits per day; and all of this without any professional marketing or assistance in the content of the site. In case you are interested, the site is maintained by Abilene Online, and they have consistently done a great job helping us with the layout and getting the information on the site in a timely manner.

Soon after returning, I will be lecturing in New Orleans at a facial cosmetic surgery course put on each year at LSU. There, I will covering topics related to advanced facelifting procedures.

That’s all for now. Keep your questions and comments coming, and thanks for your ongoing support of our Center.

Sincerely,

Howard A. Tobin, M.D., F. A. C. S.
www.newlook.org

For general information: askdena@newlook.org or n41gt@newlook.org