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HMO Will Not Authorize Removal of Leaking Breast Implants

Diana McNair - Joshua, TX
As told by Diana McNair:

I have been struggling with my HMO since 1990. Every action that I have had to take is like taking a 4 year old to the dentist for a filling. I have not been able to do anything as easy and carefree as the HMO makes it sound in their sales pitch and in their handbook.

In May of 1985, I had a double mastectomy followed by silicone breast implants which were reconstructive in nature and were subpectorally positioned. A year after the initial surgery, the left breast implant had shifted and was moving upward in position. This required reconstructive surgery using the same breast implant. That same implant is now moving downward, leaving my nipple pointing upwards.

My doctor and I believe the silicone breast implants are slowly poisoning me. I have suffered numerous miscarriages and believe the toxicity level is killing these babies in my uterus. My requests to have the implants removed by my HMO have gone unheeded, even as it imperils my health and well being.

In 1990, I started having stiff joints in my elbows, fingers, and most prominently, in my knees. This condition severely limits my daily activities, including on my worst days, difficulty in standing up and down. My HMO doctor merely recommended that I use BenGay for the stiffness. There was no connection made between the stiff joints and my implant problems.

In 1992, I faced the possibility of infertility, as I attempted pregnancy repeatedly, to no avail. After achieving pregnancy in 1992, I miscarried shortly thereafter. I underwent much testing and infertility work and finally conceived in 1994. Since then, I have had 5 more miscarriages, three of which reached the stage of a heartbeat, only to miscarry in the 12-15th week. My doctor and I believe the difficulty in getting pregnant and the 5 miscarriages are due to the toxicity level built up in my body from the silicone implants. There are many testimonials from other women who have the silicone implants and report the same predicament. Once the implants were removed, the women were able to conceive and carry a baby to birth with no problems. This is my biggest concern for wanting the breast implants removed.

In 1994, I started noticing discoloration and skin rashes on my face, upper chest and arms. The rashes developed into what I call scaly, little bumps that never go away. Additionally, in 1994 I was diagnosed with Chronic Fatigue Syndrome. Again I believe that both of these symptoms are related to the toxic nature of my breast implants.

Lastly, I have been having a burning sensation under my breast implants. It feels like they are falling out of place. The pain goes all the way through me to my shoulder blades. I desire that these breast implants be removed for the sake of my health and well being, not for cosmetic purposes. Yet, my HMO denies me coverage of this procedure by claiming that it is aesthetic in nature. Despite the many medical examinations whereby my symptoms are routinely linked to the breast implants, I am still denied coverage.

Due to the fact that I get my insurance through my employer, my HMO is protected by a federal law called ERISA (the Employee Retirement Income Security Act) which voids state protection laws. The ERISA loophole shields HMOs and insurers from paying damages when they deny medically appropriate treatment for patients who receive their health care through their employers.

I have requested the surgery four times from my HMO, only to be denied each time. I have submitted documentation and medical exam results to substantiate that my claim is for medical purposes rather that cosmetic reasons.

This is absolutely the worst nightmare of my life and it is ridiculous the extent to which I have had to go to get the service and product that I pay for every month.

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