IMPORTANT RULES AND WEB SITE AGREEMENT
Please read this Agreement carefully before accessing or using the BreastHealthOnline website. By accessing or using the site, you agree to be bound by the terms and conditions set forth below. Violation of the terms and conditions set forth below may result in your account being banned and/or legal action being taken against you if warranted. If you do not wish to be bound by these terms and conditions, you may not access or use the site.
1. You must be a woman of at least 18 years of age to use our site. By entering, using, registering, and/or logging on to this site, you certify that you are at least 18 years of age. BreastHealthOnline is not liable for any reliance by any user on the information obtained from this site.
2. We are a 501(c)(3) non-profit organization. Because of our non-profit status, you must follow 3 important rules:
a.) You may not post any political statements, positions, arguments, jokes, or discussions. They will be removed.
b.) You may not post sexually explicit material, either in the form of postings, jokes, or discussions or in the form of photographic material. Surgical photos of your breast surgery on the appropriate members only picture board are acceptable. You may discuss aspects of the safety of returning to your intimate life with your spouse or significant other in terms of your surgery and recovery, but explicit details are not necessary, nor are they welcome and are against site rules.
c.) You may not post any jokes, discussions, arguments, positions, preachings, scriptures, verses, or statements about religion in your posts or your signature lines.
Prayer requests: Posts with general information, concerns, fears, and anxiety regarding surgery and a mention of "I could use your prayers" are acceptable at the main surgery boards. Members offering well wishes to another member and stating that they have a member in their prayers is also acceptable at the main surgery boards. Off topic prayer requests are not acceptable.Starting a lead post asking for prayers is not a good idea. Asking for good thoughts and well wishes is and usually gets better results in the end.
We reserve the right to edit or remove any post (without notification) for content that puts our non-profit status in jeopardy. Questions about this policy must be addressed via our Help Desk and not on the public boards.
3. BreastHealthOnline is an adult breast surgery support site that enables people to communicate with each other on public forum boards. Opinions and views expressed and posted on these boards are views of the members who posted them and do not necessarily represent the views of BreastHealthOnline. While we own the copyright to all materials entered onto this site, we are not responsible for the content of such messages and postings.
4. You may not make libelous comments or accusations about anyone, including your physician. Unfortunate and regrettable situations can occur with any surgery. If you are an ESTABLISHED PATIENT MEMBER with a continuous posting history you are welcome to discuss what has happened to you (good or bad) and receive information and support, but you must take care to not create a libelous and defaming legal situation for yourself or for BreastHealthOnline. Any posts of this nature will be removed and you will be denied further access to the site, including loss of any privileges you formerly held. You may also be legally responsible for your actions.
Additionally, if you are a surgeon and you or your staff (wittingly or unwittingly) are using our site to post false and libelous experiences or reviews about another surgeon's practice, we will work with that surgeon to prosecute you and your staff to the fullest extent of the law. ALL users post copies will be retained for legal reasons in the event they are subpoenaed in a court of law. We will not tolerate being put in this situation on your behalf and you are legally responsible for any posts you may make, whether you are a patient, a doctor or a doctor's staff member.
Examples of acceptable posts by patients are simply relating your surgery story and what happened to you in a step by step fashion without derogatory comments towards those who were involved in your treatment or care. Examples of unacceptable posts are calling a person or physician names such a 'butcher', or 'quack', or using statements such as 'incompetent', etc. There are other finer points of 'blaming doctors' when in fact, the patient did not provide the necessary care for themselves so you might consider all aspects before making accusations. Additionally, if you feel you've suffered an egregious break down in care, you need to consult your lawyer, not use our site for justice. We will review posts on a case by case basis and apply editing and retain posts for legal reasons when necessary, without notification.
5. The entire contents of the site are copyrighted under the United States copyright laws. The owner of the copyright is BreastHealthOnline. The information and photographs found herein may NOT be copied, duplicated, downloaded, or redistributed in ANY form without the express written consent of BreastHealthOnline. We employ a variety of tracking mechanisms to preserve, detect, and enforce our copyrights.
6. Users of the site agree to treat one another with kindness and respect. We expect a high level of compassion, understanding, and decorum. Should you have a concern, question, conflict or misunderstanding with any member of our boards or staff, please contact us. Hostile arguments of any kind are not permitted on our forum boards. We will not tolerate postings that contain inappropriate language, threats, derogatory remarks, insults to particular ethnic groups, or religious beliefs or comments that we deem may make others feel unwelcome or uncomfortable. BreastHealthOnline reserves the right to remove ANY post or photograph that we feel is considered harmful, offensive, abusive, or non-productive without warning and without notification nor explanation of having done so.
7. We reserve the right to refuse access to any individual or group without prior notification to those participating inappropriately or abusing the site. Activities of this kind will be reported to their internet service provider and/or law enforcement agencies, as we deem necessary.
8. The site contains public forum boards that are accessible to the general public. All material that you post, whether it is text or photographs, has the potential to be seen by Internet users worldwide. Although access to some areas of the site is restricted, there are ways that others can illegally enter these protected areas. By posting on our boards or submitting your photographs, you understand that BreastHealthOnline has no control over this material and will not be liable for the actions of others who may misuse or illegally re-print this material.
9. Users of this site have the option of displaying or hiding their personal email addresses. If you choose to display your email address, you understand that anyone may view this address and contact you for any purpose, including solicitation and possible harassment, even though doing so is against our rules. If you wish to contact a BreastHealthOnline member who has a hidden email address, please advise the BreastHealthOnline staff and if the other party agrees, we will assist you in doing so.
10. Use of this site makes you responsible for all postings that are created from your account. We suggest that you use a password specific to BreastHealthOnline and that you not allow the use of your computer by anyone who may abuse our rules. Do not post your home address, phone number, or other personal information on ANY boards on the site. Posts with information such as addresses or phone numbers will be removed by BreastHealthOnline for your protection, but we are not responsible for any consequences you may suffer between the time you post personal information and we remove it.
11. BreastHealthOnline makes no warranties that the information contained herein is in every respect accurate or complete and is not responsible for any errors or omissions or for the results obtained from the use of such information. The information contained herein is not intended to replace medical advice offered by physicians or other healthcare professionals. While the surgeons we recommend and list in the site have met certain criteria, no guarantees can be made by us regarding the expertise of the individual surgeons presented. We strongly urge prospective patients to independently confirm all qualifications and expertise of the selected surgeon by contacting the medical boards and surgical societies to which they belong. BreastHealthOnline disclaims all liability resulting from treatment by any doctor listed on the website. In no event shall BreastHealthOnline have any liability for incidental or consequential damages. It is solely your responsibility to evaluate the accuracy, completeness, and usefulness of all opinions, advice, services, merchandise, products and other information provided through the site.
12. You may not post or transmit any advertising, promotional materials, or any other form of solicitation on the site unless PRIOR authorization is granted by BreastHealthOnline.
13. You agree to indemnify, defend, and hold harmless BreastHealthOnline, its officers, directors, employees, agents, licensors, suppliers, and any third party information providers to the site from and against all losses, expenses, damages, and costs, including reasonable attorneys' fees, resulting from any violation of this Agreement by you.
14. As a non-profit, our organization is governed by the 501 (c) 3 laws and guidelines as outlined by the Internal Revenue Service. Rules about advertising through a non-profit are very strict. Members are not allowed to post websites on our non-profit. Soliciting BreastHealthOnline members to purchase products, goods, or services or to visit other websites via emails or posts is not allowed and can result in site access denial or legal action being taken against you. You may post your homepage in your stats, but urging members to visit your stats in order to visit your page is the same as posting your URL on the site directly and is against site rules. You may not add your web site URL to your signature line. Offering your email address and inviting members to email you for further information about advice or a URL is the same as posting your personal, professional, or alternate website address on the site and is against site rules. Members soliciting other members in this fashion may have their access permanently denied, including any non-refundable membership accesses you may hold.
15. You may not request or solicit another member to email you their pre- or post-surgery photographs. You may not offer to send another member your pre- or post- surgery photographs. BreastHealthOnline has designed several restricted access boards to post photographs. To apply for access to these boards please go here.
16. Surgery is stressful, and everyone says insensitive things or snaps at another person occasionally. Try to understand that a member may be in pain or having a really bad day. Should you need to address the situation, however, please respond to that person in a calm, open, and diplomatic manner and allow that person to make amends. Alternatively, if you are addressed about a post that was hurtful to another member, please bear in mind all that was said above and try to make amends with the person if at all possible. We're all just human. These are not just suggestions; we expect these guidelines to be followed should a problem arise. We also may remove the posts of such a situation once it has been resolved since they are not part of our breast health support and have no value to the other members.
Please enjoy our site. Our incredible staff and caring members are a wonderful group of supportive people from all over the world who offer advice, friendship, and concern collectively as a community to all that visit.
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The Staff at BreastHealthOnline
Healthcare lingo is complicated. Negotiating the slew of acronyms and information can be infuriating.
Not knowing how your plan works can cause confusion and cost you a significant amount of money.
All health insurance works basically as follows: In exchange for a monthly premium, you can visit a provider (doctor/hospital/physical therapy, etc) and your insurance company will pay for what they think it should cost. Most of the time, there isn’t much of a disparity between the provider’s billing and what the insurance company considers appropriate, but keep in mind that the insurance company basically reserve the right to pay (or not as the case may be) for whatever part of the bill they want. Either way, if you get hit by a car, fracture fifty bones, and need facial reconstructive surgery, those pesky thousands in premiums just saved you somewhere around a million bucks.
To slightly complicate matters, most insurance plans require a deductible, a co-pay, or both. A deductible is the predetermined amount that you have to spend on medical services in a given year before the insurance company starts paying. The lower the deductible, the higher the price of the plan, because your insurance is basically agreeing to pick up a larger portion of the bill.
Then the co-pay comes in. Basically, health insurance companies hate giving away anything for free and make you pay a small amount (between $105-$50 usually) for seeing a doctor after you’ve already gone over your deductible. You’ll often pay a higher co-pay for a specialist, urgent care or emergency room care. Often ER care has the highest co-pay to encourage you to use your doctor or urgent care centers when at all possible.
Most insurance companies cap the amount of out-of-pocket expenses you will have to pay and also put a maximum on the amount they will cover. Nowadays, almost every company or individual insurer has to choose between a number of different plans called Managed Care, each of which has its own acronym that doesn’t correspond in any way to what the plan offers.
Managed care is a system of health insurance that helps insurance companies make money while placing limits on the doctors/providers and services a member can use. There are several types of Managed Care Organizations, each with an acronym. Including HMO, PPO, POS, and EPO. Whichever on you choose, you are going to want to find the right primary care physician (PCP). Your PCP can help you determine which specialists you see, support any claims you have for services the insurance company wants to deny. Thus the PCP can greatly influence the quality of the care you receive.
In an effort to keep costs down, Health Maintenance Organizations (HMOs) place restrictions on the services a patient may receive. Under an HMO, the policyholder chooses a primary care physician (PCP) from the HMO’s list. After you choose your PCP, you must visit them for any medical issue. The PCP then decides whether your ailment is bad enough to warrant visiting a specialist. But you are only covered if you see a specialist that is part of your plan. This system keeps costs (and your premium) low, but can be annoying if you want to skip the step of visiting our PCP.
Preferred Provider Organizations (PPOs) give you a choice of where to receive services, with the possibility of paying more out-of-pocket depending on where you choose. If you have a problem, usually you can go straight to the specialist without first getting approval from your PCP (always check with your insurance company first to see if you can directly go to a specialist). If that specialist is a member of the PPO, insurance covers a much higher percentage of their services. However, if you don’t like their specialists and want to see the best surgeon in the area, who happens not to be a member of the PPO, you will still be covered for a certain percentage of the visit.
Ultimately, going out-of-network for medical services can cost you thousands of dollars in expenses that you could have avoided. Unless you are very uncomfortable with the choices given, there is no reason not to stay within your network.
Point of Service (POS) plans are essentially a merger of HMOs and PPOs. Like an HMO, you choose a PCP and visit them for referrals. Once a referral is made, you can choose to stay within the network, or venture outside and pay more out-of-pocket, just like with a PPO. Sometimes, you can even skip the visit to your PCP if you know the out-of-network specialist you would like to visit.
An easy way to understand an Exclusive Provider Organization (EPO) is to think of it as a PPO with restrictions, thus often costing less in premiums than a PPO. The list of providers you can visit is much smaller than with a PPO, and if you go out-of-network your services may not be covered at all (except in emergency cases). Seriously consider whether an EPO is worth the savings, the selection of providers is small, and if you need to go out-of-network you may have to cover the entire bill.
Important terms to understand and review on your specific health insurance plan
Annual Deductible: The amount you pay for covered health services before you are eligible to receive benefits.
$700 per Covered Person per calendar or plan year, not to exceed $2800 for all Covered Persons in a family.
Couples with no children have a $1400 In-Network deductible ($700 x 2).
Couples with 1 child have a $2100 In-Network deductible ($700 x 3).
Couples with 4 children have a $2800 deductible, as would couples with 6 children.
This is because the MAX deductible in this plan is $2800 for all Covered Persons, regardless of how many are in the covered family
$2800 per Covered Person per calendar or plan year, not to exceed $11,200 for all Covered Person in a Family.
Couples with no children have a $5600 Out-of-Network deductible ($2800 x 2)
Couples with 1 child have an $8400 Out-of-Network deductible ($2800 x 3).
Couples with 4 children have an $11,200 Out-of-Network deductible, as would couples with 6 children.
This is because the MAX Out-of Network deductible in this plan is $11,200 for all Covered Persons, regardless of how many are in the covered family
Out-of-Pocket Maximum (OOPM):
The maximum you pay out of your pocket in a calendar or coverage year for co-payments. Most health insurance policies renew every 01/01 of each year. But some policies such as for school systems may renew every 08/01.
$2000 per Covered Person per calendar or plan year, not to exceed $8000 for all Covered Persons in a family.
Couples with no children have a $4000 In-Network OOPM ($2000 x 2).
Couples with 1 child have an $6000 In-Network OOPM ($2000 x 3).
Couples with 4 children have an $8000 In-Network OOPM, as would couples with 6 children.
This is because the MAX In-Network OOPM in this plan is $8000 for all Covered Persons, regardless of how many are in the covered family.
$4000 per Covered Person per calendar or plan year, not to exceed $16,000 for all Covered Person in a Family.
Couples with no children have a $8000 Out-of-Network OOPM ($4000 x 2)
Couples with 1 child have a $12,000 Out-of-Network OOPM ($4000 x 3).
Couples with 4 children have a $16,000 Out-of-Network OOPM, as would couples with 6 children.
This is because the MAX Out-of Network OOPM in this plan is $16,000 for all Covered Persons, regardless of how many are in the covered family
When covered health services are received from non-network providers, eligible expenses are determined based on either the Fee(s) that are negotiated with the provider OR the Available data resources of competitive fees in the geographic area.
NOTE: If care is received from a non-network physician, facility, or other health care professional you will incur greater financial expense compared to an in-network provider. Your plan only pays a portion of those charges and it is your responsibility to pay the remainder. Youa re required to pay the amount that exceeds the allowable amount, which could be significant, and that amount does not apply to the Out-of-Pocket Maximum. It is recommended that you ask the non-network professional about their billed charges and/or negotiate what you will need to pay BEFORE you receive care. Some physicians will perhaps agree to accept in-network fees plus you cover 10% of remaining fees. Get any negotiated agreement in writing before receiving care.
Maximum Plan Benefit:
The maximum amount your plan will pay for non-network care during the entire period of time you are enrolled under the plan. (PLEASE NOTE: Removal of lifetime plan maximums are part of the Healthcare legislation recently approved. Refer to any new plan booklets or summaries to see the outcome of the provision change).
The percentage of eligible expenses you are required to pay for covered health services after you meet the annual deductible.
For example, you may be provided two options when enrolling in the insurance plan, such as:
90% of eligible expenses after satisfying $700 deductible until Out-of-Pocket maximum is reached, OR
70% of eligible expenses after satisfying $1400 deductible until Out-of-Pocket maximum is reached.
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Tell us these four things - just copy them into your email:
1. Which surgeon you saw.
2. What color and image is on the back of the card.
3. Which surgery you're seeking.
4. What username you'd like.
From there we'll help you set up a premium access account to all our forums, picture boards, insurance specialist, RN, personal Healing Diet help and more, all while saving you a tidy $25 in the process - a nice amount to buy a pretty new bra! Oh, plus you'll get loads of help all along the way from us, too!
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