No snow softened the bare outlines of trees and ground in Ronkonkoma, Long Island in the winter of 1997. Janet Franquet, 32, a new mother and nurse at a rehabilitation center and nursing home, looked forward to celebrating Christmas with her husband, Robert, and their baby, Michael. But in the midst of that festive season, Janet was diagnosed with inflammatory breast cancer (IBC) - rare and very aggressive, diagnosed more often in younger women. After undergoing chemotherapy in an attempt to shrink the cancer, Janet’s next course of treatment was a mastectomy. Since IBC infiltrates the lymphatic vessels of the breast skin, Janet’s surgeon planned an immediate abdominal flap breast reconstruction, which would use her own abdominal skin and fat to restore her breast and close the wound.
But the day before surgery, her insurance provider denied her coverage, saying the procedure was cosmetic. They suggested her surgeon use a pig skin graft instead. “I was numb,” Janet said later. She and her surgeon, Dr. Todd Wider, began a lengthy appeals process with the insurance company.
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| Janet Franquet - Christmas 1995 Photo lovingly provided by her twin sister, Joyce Gagliardi |
Some states, including Janet’s home state of New York, had already passed laws barring insurance companies from denying coverage for breast reconstruction after mastectomy. But they didn’t cover self-insured employer plans, which are under federal jurisdiction. Robert provided the health insurance for the family through his job as a truck driver, via his trade union. Unfortunately that fell outside the new state law.
Watching this young mother endure the assaults dealt her by both cancer and her insurance provider, Dr. Wider called upon Carol M. Baldwin, a breast cancer survivor and well-known breast cancer advocate (and mother of several famous actors). Two years prior, she and her family and friends had founded the Carol M. Baldwin Breast Cancer Research Fund. She was able to use her influence to enlist help for Janet from then U.S. Senator Alfonse D’Amato.
Thankfully, Dr. Wider went ahead with the reconstructive surgery, generously providing his services free of charge. Eventually the insurance company reversed its decision.
Janet was determined to fight for the medical coverage to which she believed every woman in her circumstance had a right. Her bravery filled D’Amato with similar resolve. “What happened to Janet Franquet was tragic,” he said. “It should never happen again.” On the floor of Congress, D’Amato championed for passage of a law that would require all insurance companies to cover breast reconstruction. D’Amato said, “I ask you, Mr. President, how many other Janet Franquets are out there? Will they be lucky enough to have a Dr. Wider to take care of them?” On October 21, 1998, the Women’s Health and Cancer Rights Act (WHCRA) was signed into federal law and officially named “Janet’s Law.”
Today, too many women remain unaware of this legislation. They mistakenly believe breast reconstruction after cancer is considered cosmetic and thus beyond their financial means. But Janet’s Law states that if a woman has health insurance covering mastectomy, breast reconstruction and surgery to attain symmetry are covered as well.
Janet lost her battle with cancer in May of 1999. In her obituary, D’Amato was quoted, “She demonstrated great courage during her short time on this earth. She said to me, ‘Maybe God put me here so that I could do this.’” He added, “She was the inspiration for a national law which now says every woman is entitled to reconstructive surgery. If not for Janet Franquet, I don’t think this would have happened.”Janet’s Law states:
(a) IN GENERAL -- A group health plan, and a health insurance issuer providing health insurance in connection with a group health plan, that provides medical and surgical benefits with respect to a mastectomy shall provide, in a case of a participant or beneficiary who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with such mastectomy, coverage for--
(1) All stages of reconstruction of the breast on which the mastectomy has been performed;
(2) surgery and reconstruction of the other breast to produce a symmetrical appearance; and
(3) prostheses and physical complications of mastectomy, including lymphedemas;
in a manner determined in consultation with the attending physician and the patient.
Thank you, Janet.
At age 55 I was very active, working and pursuing a healthy diet and lifestyle for some years prior. I was self employed with no Health Insurance. Eating orgainic and taking nutritional supplements is expensive, but I felt it was my Health Assurance. So the budget didn't include Health Insurance too. Then I was diagnosed with rare Triple Negative Breast Cancer in 2011. Here's the Breast of 'MY' story......
ReplyDeleteI went through the Breast and Cervical Cancer screening program available in my state. When I received a Breast Cancer diagnosis I was automatically enrolled in Medicaid since I had no Health Insurance. With all the future treatments I was facing you can imagine how blessed I was to receive Medicaid. God Bless America!
After my mastectomy I didn't even consider Breast Reconstruction, for one reason, I didn't think Medicaid would cover it and I was right. I was glad to get the mastectomy and save my life. My breast surgeon had advised me about Reconstruction and that the best work he thought being done was in New Orleans. I checked out their website and learned about WHRCA 1998. This gave me the possibilty of Breast Reconstruction for myself. The Breast Center in New Orleans could not take my out of state Medicaid Insurance, so I searched for a plastic surgeon in my state. I was sorely disappointed to find out that my state's Medicaid does not cover any type of Breast Reconstruction and that the WHRCA 1998 Federal law does not apply to my Medicaid. I don't understand that but it is what it is. So instead of giving up I turned to my faith for a way where there seemed to be no way. I've been blessed with benovolent financial aid apart from Medicaid and I was able to get the best Reconstruction available at the Breast Center in New Orleans. The staff there worked for me and with me and my Breast Reconstruction has become a reality.
WHRCA 1998 didn't apply for me, but I'm still grateful for Medicaid because it saved my life. My christian brother's and sister's helped me to have my breasts back. God has blessed me with a new lease on life and a whole new perspective of His Grace and what it means to walk with Him daily. I've learned that no matter how long or 'short' our journey is in this life, knowing our destination is all that matters. I'm thankful that my God has sustained this dumb little South Mississippi gal and continues to teach and bless me every day with every trial. Jesus is my advocate. He is my Lord
Great post, Eve!
ReplyDeleteAnonymous,
ReplyDeleteStay tuned for the next blog post where I intend to address the issue of how well the law is/is not always being implemented. Seems like insurance companies are making it increasingly difficult for women wanting breast reconstruction after cancer. Lots of hoops to jump through and sometimes a brick wall. I was aware that Medicaid/care compensates only a small percentage of what the costs actually are, often making it very difficult or impossible to find a surgeon willing to take on those patients or to provide the type of reconstruction that should be up to the woman and her doctor to decide. I was unaware, however, that Mississippi actually refuses to cover any reconstruction costs whatsoever. I agree that it makes absolutely no sense that this federal law does not apply to Medicaid! I'll definitely look into which states have this policy. I'm so sorry you had to deal with this problem, in addition to the cancer itself, but I'm so glad you were finally able to have your reconstruction at the facility of your choice. Thank you so much for sharing the "breast" of your story! I welcome stories from other women who have had similar difficulties, either with Medicaid/care or health insurance companies.