THE EXPLANT FINANCIAL ASSISTANCE PROGRAMPO Box 1028, Birmingham, AL 35201 | 205-252-6784
The Common Benefit Trust has set up the Explant Financial Assistance Program to provide up to $5,000 in financial assistance for women who believe that their health requires them to seek surgical removal of their breast implants. If you have been considering surgical removal, or feel you are in need of this surgery, you are urged to carefully read the following questions-and-answers. Presented below is all of the essential information that you need to know about qualifying for explant financial assistance.
1) I need to get my breast implants removed, who is now eligible for financial assistance through this Program?
If you have looked into this Program in the past, you are likely aware that it had a number of requirements that applicants had to meet in order to qualify for the assistance. From our experience with both women in need of implant removal surgery and plastic surgery practices, we have now made significant changes that simplify the Program. The only requirements in place now for eligibility are that
1. You can provide proof that you have received breast implants, regardless of type; and
2. If you have health insurance, that you have been denied insurance coverage for explant surgery.
2) What does the Financial Assistance cover?
The financial assistance reimburses for costs that are incurred for surgical removal of breast implants—up to a $5,000 limit. These costs are the surgeon’s fees for explantation (removal) and capsulectomy, the anesthesiology fee, and the fee for the operating room, also called the facility fee. Surgeon’s fees for mastopexy (breast lift) are also included. Any surgery costs over $5,000 are your financial responsibility.
The assistance does not cover surgery and related fees for reconstructive surgery (other than mastopexy, i.e., breast lift) performed during the same operation, or costs for implantation of a new set of implants. These fees can cause a surgery to cost on average well over $7,000, and if you decide to have these procedures, you are financially responsible for them.
No doubt you are seeking explant surgery due to the fact that you think that you are having medical problems with your current implants. If you believe your current medical problems are caused by the implants that you want removed, you should give careful thought before getting a replacement set of implants because you may, in light of your current need for surgery, face similar health and financial problems from a new set of implants. As you think about your options, we encourage you to obtain as much information as possible. An excellent resource on problems associated with breast implants is https:/www.breastimplantinfo.org.
3) I had my implants taken out in 2013; can I apply for the $5,000 assistance as reimbursement for my payment for the operation?
No. This Program has been operating since April of 2015. It is not a long-term reimbursement program like the Explant Payment Benefits you may have heard about in the class action settlements related to breast implants. The purpose of this Program is to assist women who currently have implants and who now wish to get them removed. This means that the Program provides financial assistance in the form of short-term reimbursement for the costs the Applicant incurs in undergoing the explant surgery.
4) What steps do I need to take to receive this financial help?
a. Complete and send in the Application for Explant Assistance, available by clicking Here.
b. The Application must be sent in with Proof that you have the breast implants that are in need of removal. This Proof, as explained in the Application, should ideally be a copy of the plastic surgeon’s report of your implantation surgery. If that report is not available, you can submit other papers you received from the plastic surgeon or the manufacturer, such as exam notes, implant labels or stickers, or brochures from the manufacturer.
If some sort of proof of your surgery from the plastic surgeon is not available, you can submit an Implant Proof Witness Form, filled out by someone who knew you when you had your implant surgery. This form is available by clicking Here. Instructions for completing this Form are contained in the Application.
Your Application cannot be processed and acted on without Proof of Implantation. Also, If you have health insurance coverage, your Application cannot be processed and acted on without you having made a request to your current insurer for coverage of the explant surgery that has been denied (refer to questions 5 – 7, below).
c. If your Application is approved for financial assistance, and funds are still available, you will be notified by mail with further Instructions. These Instructions include three additional forms that should be sent back to us. These forms are a Release and Medical Provider Direct Authorization Form for your completion and signature, an IRS Form W-9 for your completion and signature, and a Cost of Surgery Certification Form for completion by the plastic surgeon who is removing or has removed your implants.
5) I have health insurance, is it possible that this will pay for my explant surgery?
First, if you have health insurance through a medical insurance company, including one in connection with Medicare, we can only assist you if you have been denied coverage of your explant surgery by the insurer before sending in your Application for Financial Assistance.
This means both that you should 1) ask your insurance company if it will cover your explant surgery and 2) receive a denial from them before you send in your Application. This request does not have to be in writing, it can be done over the phone by you or someone from the plastic surgery practice you are consulting. Also, in case of denial, you don’t have to go through the insurance company’s appeal process to get a decision for coverage.
An excellent resource exists to help people understand if their insurance might cover explant surgery. Therefore, if you are trying to find out whether your health insurance policy will cover the surgery or find it difficult to obtain information, you should contact the Insurance Coverage Assistance Program, operated by the National Center for Health Research in Washington, D.C., at 202-223-4000. Their website is https://www.breastimplantinfo.org.
This is a public advocacy group specializing in womens’ health issues, including insurance coverage for breast implant removal.
6) My health insurer told me that it will ‘cover’ my surgery, but it looks like I will still end up owing a significant amount of money to my plastic surgeon; can I still apply for and receive financial assistance from this Program?
No, please see the preceding question and answer. If insurance will cover at least one part of the explant surgery costs (as defined above) financial assistance through this Program is unavailable, as this makes more money available for women who are either uninsured, or who have been denied coverage.
However, if your insurance company informs you that it will cover your surgery, but you must pay a deductible amount under your policy that exceeds the cost of your explant surgery (meaning the total of the following costs: surgeon’s fees for implant removal, capsulectomy, mastopexy, facility fee, and anesthesiology fee), you may still be considered for financial assistance through this program upon submission of documentation by you of your applicable deductible amount.
7) What if I cannot find a plastic surgeon that accepts health insurance; or my health insurance limits coverage for my explant surgery to plastic surgeons in its network and I would like to go to one outside of network?
First, in order for you Application to be screened, a request for coverage must be made to your health insurance company. The Application will not be assigned a file and a submission number without this request.
If your health insurer will cover your surgery, but you cannot find a board-certified plastic surgeon within reasonable distance of where you live that accepts insurance; or, your health insurer limits its coverage to a restricted network of plastic surgeons, you should include with your Application a clearly written explanation of your circumstances. For example, if you cannot find a plastic surgeon within reasonable distance of where you live, you should describe your efforts to find such a surgeon. If you are restricted to certain plastic surgeons in your insurer’s network, provide a written explanation of why it is important to you to go to an out-of-network surgeon for your surgery. We will consider your explanation, and if we believe it is reasonable, you will be determined eligible for financial assistance without accessing your available insurance.
8) If my Application is approved, how is payment made by the Program?
After your surgery, you send us a copy of the plastic surgeon’s written report documenting the removal of your implants, along with an itemized statement of your surgery expenses, and the plastic surgeon’s Cost of Surgery Certification Form. When we have received these documents, a check payable directly to you in the amount of your allowable explant-related surgery costs up to $5,000 will be authorized.
9) Why is payment made after I have the explant surgery when my plastic surgeon is requiring me to pay up front?
We cannot structure a Program intended to assist hundreds of applicants so that financial assistance is paid out to the surgeon before surgery. Furthermore, we need proof that the surgery has taken place before we issue the payment. Five thousand dollars in assistance is a significant sum.
In administering this Program, we learned that the women to whom we were giving financial assistance still had to pre-pay the plastic surgeon, either by credit or short-term loan. This is because most plastic surgeons have to make non-refundable deposits in order to reserve an anesthesiologist and an operating room for the surgery. As part of the simplification of the Program, the financial assistance will now be issued directly to the Applicant, who in most cases has had to arrange short-term financing in order to pre-pay the surgeon. While this is not the most ideal situation for someone in need of financial assistance, it has still proved to be a workable approach for our applicants who are in dire need of explant surgery.
10) How long will it take me, assuming that I successfully apply, to get my implants removed and to receive payment?
The time it takes from your submission of the Application for Explant Assistance—to explant surgery and payment, depends on various factors that can differ from person to person. In situations where a plastic surgeon must be found who is willing to perform the surgery, the amount of time can be a few months. Where the applicant already has a relationship with a plastic surgeon willing to assist her, it can be as short as a month.
There are some things you can do to make sure the approval, surgery, and payment process go smoothly:
First, read the Application for Explant Assistance thoroughly before trying to fill it out. Questions that you leave unanswered, answers that you provide that are unclear or inconsistent with other answers, may slow down the time it takes you to have surgery and get the financial assistance. Again, your Application cannot be processed without submitted proof that you have the implants in need of removal and the required insurance information (refer to questions 5 -7, above).
Second, promptly complete and return your Financial Assistance forms (see question 4) c., above). Failure to return these forms can delay your payment, or even disqualify you.
Third, have a plastic surgeon lined up so that you can promptly schedule the operation if your Application is approved for assistance.
11) I have already scheduled my explant surgery for next week; can you give me a quick decision on whether or not I am approved for the financial assistance?
No. Again, in operating a Program intended to assist hundreds of applicants, it is not normally possible to do this. All decisions of approval are given in writing. If you have already been able to get a surgery date before you send in your Application, this usually means that you have been able to pay the surgeon up front and that you are not totally depending on financial assistance from this Program. However, assuming that you submit an Application and proof of your implantation, it will receive the same consideration as every other Application, and you will receive approval for financial assistance as long as funds are still available.
A CHARITY PROGRAM
12) What if you determine for some reason that I am not eligible to apply for assistance, but I believe that I have met the Proof of Implant requirement and the no-insurance coverage requirement; can I appeal to someone else to review my Application?
No. All determinations of the Program Administrator are final. The Explant Financial Assistance Program is not a “claims program.” It is an initiative of the Common Benefit Trust that is charitable in nature. While the available funds for this Program come by court approval from surcharges assessed in the MDL 926 Revised Settlement Program, it is not a part of that settlement (which has closed). Likewise, the Program is not a part of the Dow Corning Settlement. Applications are simply requests for assistance. The funds available for this Program are limited, and the Program may be modified or terminated at any time.