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A Complicated Issue A Weekly Check on Health Care Costs and Coverage Tuesday, January 20,
2004; Page HE02
Amy Kephart's routine mammogram last year proved to be anything but routine. The image for her left
breast led her doctor to recommend a needle biopsy. The biopsy, Kephart said, led to an infection.
The infection required surgery that kept her in Inova Fair Oaks Hospital for several days in
September, costing her more than $1,000 and her insurance plan thousands more.
Case closed? No. In December, her insurer, the Health and Welfare Fund of the United Food and
Commercial Workers Union, asked the various providers for its money back, saying Kephart's claims
had been paid in error. "It has come to our attention," the fund wrote, that Kephart's treatment
"was due to complications from previous breast implants approximately 10 years ago," and under
Kephart's policy, "Complications resulting from cosmetic surgery are not covered."
Kephart, who lives in McLean and works for Safeway, is appealing the denial, and she has hired an
attorney to try to ensure that she won't be stuck with the bills. Regardless of how her case turns
out, it illustrates some of the problems facing women who have breast implants, either after
mastectomy or to enhance their physique.
"This implant needs to be removed in order to allow for resolution of the . . . infection," plastic
surgeon Andrew G. Goldberg wrote in a memo before operating on Kephart. In a follow-up, Goldberg
reported that he had found the implant to have been ruptured, "with free silicone within the left
breast tissues."
"Usually things are kind of black or white," Goldberg said, but sometimes deciding whether a breast
problem is a complication of an implant "is absolutely a gray zone," and "unfortunately the
insurance companies are making the final determination."
Kephart said she was unaware of her policy's exclusion of cosmetic-surgery complications. If she had
known that the biopsy and mammogram might confront her with expensive health problems, she said, she
would have skipped them.
"You certainly don't want her not to have mammograms," said Diana Zuckerman, president of the
National Center for Policy Research for Women & Families, "because the mammogram could help you find
out if you have breast cancer."
Zuckerman said she did not know of others avoiding tests for financial reasons, but "I hear more
from women who don't want to get mammograms because they're afraid their implants will break"
during the exam.
"I've spoken to so many women who say this has happened to them," said Zuckerman, whose group
promotes research on the safety of implants. "It certainly seems likely that a mammogram can break a
breast implant."
Indeed, the Food and Drug Administration urges women to alert mammogram technicians to "use special
techniques . . . to avoid rupturing the implant."
-- Tom Graham
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