THE EXPLANT FINANCIAL ASSISTANCE PROGRAM

PO Box 1028, Birmingham, AL 35201 | 205-252-6784

1. I need to get my breast implants removed, can this Program help me?

The Common Benefit Trust has set up this Program to provide up to $5,000 in financial assistance for women who are now thought to have the most pressing medical and financial need for breast implant removal surgery.  If you still have at least one breast implant in your body containing silicone gel that you were implanted with before December 31, 2006; and this implant is ruptured, or you have other health problems such as inflammation or severe contracture; and you don’t have Medicare or health insurance coverage or the ability to pay for the surgery, this Program may be able to assist you.  There are eight requirements that you must satisfy in order to be eligible for financial assistance.  We recommend that you carefully read through these requirements, which are given on the cover page of the Notice of Interest form.

2. What if I have saline breast implants in need of removal, can this Program help me?

In certain limited circumstances, this Program will provide financial assistance for the removal of saline-inflatable devices.  Please refer to questions 13) – 16) below, for more information.

3. I had my implants taken out several months ago before I found out about this Program; can I apply for the $5,000 assistance as reimbursement for my payment for the operation?

This Program was not established to be a reimbursement program, but instead to assist women who currently have implants and who are looking for a way to get them removed.

SCREENING AND APPLICATION

4. What steps do I need to take to receive this financial help?

 If you have reviewed the eight requirements and believe that you meet them, these are the steps you must take:

  1. Complete and send in the Notice of Interest Form.
  2. If it appears from your answers in the Notice of Interest that you may satisfy the eight requirements, we will send you an Application Package to complete and send back to us.
  3. It is your responsibility to find a plastic surgeon that is willing to perform your explant surgery.

5. What is the Notice of Interest form?

The Notice of Interest form can be found at the above link.  This is a six-page questionnaire about your history with breast implants, your income, claims history, and your current insurance situation.  This form helps us understand your pressing medical and financial need for explant assistance.  If it appears that you may be eligible for assistance, and there are sufficient funds available, you will be invited to submit an Application Package.

6. What is the Application Package?

The Application Package requires you to submit documentation to us that support the responses in your Notice of Interest form.  In addition, you will be asked to certify in writing that you meet the eight requirements.  You must also identify a plastic surgeon for us, which means that one has told you that he or she is willing to perform your explant surgery.  If the Application Package establishes that you are eligible for financial assistance, and there are sufficient funds available, we will notify you that your application is allowed, meaning that we are willing to provide up to $5,000 in assistance towards surgical removal of your breast implant(s).

7. I’ve already looked into the cost for getting my implants removed, and it is over $5,000.

We acknowledge that explant surgery often costs more than $5,000.  Any amount over $5,000 is your financial responsibility.  (Similarly, if private health insurance covered the surgery, there might be co-payments, coinsurance, or annual deductibles for you to pay.)  The funds available to provide financial assistance to women in need of removal are limited; and $5,000 is considered to be a fair maximum amount at this time.  The $5,000 in assistance is applied to the surgeon’s fee(s) for removal of the implants and capsulectomies, as well as anesthesiology and facility fees.  Any replacement with saline implants or reconstruction done with the explantation surgery, although permissible, is excluded from this calculation.

PAYMENT

8. If my Application Package is determined eligible, do I receive a check from you to use for the surgery?

 No.  If your application is allowed, we directly pay the plastic surgeon after he performs your explant surgery.  At the time you are determined eligible for assistance, you will be given further instructions for you and your plastic surgeon to follow in order to proceed with the surgery and finalize the payment.

9. What if my plastic surgeon is willing to participate in this program, but still insists on receiving full payment from me before the surgery?

Practically all plastic surgeons have an official policy requiring full pre-payment for surgery.  Some who participate in the Program graciously waive the pre-payment requirement.  Other surgeons no doubt would, but must receive pre-payment because they are in turn responsible for making sure that the facility and the anesthesiologist get paid for their contribution to the surgery.  Unfortunately, we cannot structure the Program so that financial assistance is paid out to the surgeon before surgery, because we need proof that the surgery has taken place before we issue the payment.  Five thousand dollars is a significant sum.

In these circumstances, the women we assist pre-pay the plastic surgeon, either by credit or short-term loan, and are reimbursed post-surgery by the doctor in the amount received from us.  This is one of the reasons that we attempt to issue payment as quickly as possible when we receive a copy of the operative report.  We understand that having to arrange short-term financing can be inconvenient, and while not the most ideal situation, it has still proved to be workable for the women we assist who are in dire need of implant removal.

10. How long will it take me, assuming that I successfully apply, to get my implants removed and for the physician to receive payment?

The time it takes from your submission of the Notice of Interest—to explant surgery and payment of the plastic surgeon, depends on various factors that can differ from woman to woman.   In situations where a plastic surgeon must be found who is willing to perform the surgery and participate in this Program, the amount of time can be a couple of months.  Where the applicant already has a relationship with a plastic surgeon willing to assist her, it can be as short as a few weeks to a month.

There are some things you can do to expedite approval, surgery, and payment.

First, read the instructions on the Notice of Interest form thoroughly before filling it out.  Questions that you leave unanswered will slow down the process.

Second, meet any deadlines that you are given for submitting further forms and information.  Missing deadlines may disqualify your application.

Third, have a plastic surgeon lined up so that you can promptly schedule the operation if your application is determined eligible for assistance.   (But you will not undergo the surgery until after you are notified that your Application Package is eligible.)

INSURANCE

11. What if I am not eligible for the Explant Financial Assistance Program because I may be eligible for Medicare or have private insurance?

If the reasons for your ineligibility have to do with you having potential or existing health coverage, and if you are having difficulty obtaining coverage for your removal surgery, you should contact the Insurance Coverage Assistance Program, operated by the National Center for Health Research in Washington, D.C. They may be reached at 202-223-4000. This is a public advocacy group specializing in womens’ health issues, including insurance coverage for breast implant removal.  The National Center for Health Research is receiving a companion grant from the Common Benefit Trust to provide practical information and advice to women on how to obtain insurance coverage to cover explant surgery.

A CHARITY PROGRAM

12. What if you determine that I am not eligible to apply for assistance, but I believe that I meet the eight requirements, can I appeal to someone else to review my Notice of Interest; or what if I submit an Application Package that is determined by you to be ineligible for assistance, can I appeal?

 

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.

SALINE IMPLANTS

13. I have read anecdotes that some women who do not have gel-filled breast implants have been approved for assistance for explantation of their saline implants.  On the other hand, the Eligibility Requirements limit eligibility for assistance to silicone gel or double lumen implants, what is going on?

Women with saline-inflatable breast implants who have been under the care of a board-certified rheumatologist, neurologist, or internist for symptoms or illnesses that deprive them of the ability to consistently work, or who have applied for disability benefits as a result of such symptoms or illnesses, can now be considered for Special Hardship eligibility for explant financial assistance upon submission of the Notice of Interest form.

14. What is Special Hardship eligibility for saline implant recipients?

Special Hardship status is an exception to meeting the first Eligibility Requirement that the applicant have a) gel-filled breast implants implanted b) before December 31, 2006, as found on page one of the Notice of Interest questionnaire.

 15. How is a Notice of Interest assigned Special Hardship status for saline implant removal?

In order to be considered for Special Hardship status, saline implant recipients who complete the Notice of Interest form should, in the space on page 4, under ‘Reasons for Needing Explantation’, list their symptoms and/or diseases; and indicate that they have seen a board-certified rheumatologist, neurologist, or internist, and/or applied for disability benefits.  Local complications such as leaking, rupture, capsular contracture, calcification, and chronic inflammation/pain will not be considered for Special Hardship status.

If a Notice of Interest passes screening for Special Hardship status, the applicant will be invited to submit an Application Package [See Question 6), above].

16. What are the requirements for an Application Package for saline implant removal?

If the Notice of Interest questionnaire is assigned Special Hardship status, applicants should be prepared, and will be requested, to submit document(s) showing:

  1.  that one has been examined by a board-certified rheumatologist, neurologist, or internist; or that one has applied for disability benefits, as a result of the symptoms and illnesses believed to be caused by their saline implants, and
  2. Second, that these symptoms and illnesses limit or deprive one of the ability to stay employed, or otherwise consistently work in one’s profession, including caring for oneself and other members of one’s household.  ‘Consistently’ means that one cannot work or provide care for oneself or others on a predictable, day-to-day basis.