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Topic: Mastectomy and Medicare

Forum: Employment, Insurance, and Other Financial Issues —

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Posted on: Oct 23, 2020 10:03AM

vifl wrote:

Hi all, I am recently diagnosed with stage 1 in the left breast. I have other health issues so I opted to have have a bilateral mastectomy and go flat. I think it will be least amount of trauma procedure for my body. I have an autoimmune disease as well that is trying to flare up and I can no longer take the medication that was controlling that with this cancer diagnosis. Hopefully after I recover from the mastectomy we can find another treatment for that. one thing at a time. I am on Medicare and even though my Dr. says both breasts will be covered by it, I can't find anywhere that says they will actually cover the non cancerous breast to be removed. Has anyone had experience with this similar situation? Kansas

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Oct 23, 2020 01:58PM flashlight wrote:

Hi vifl, I didn't have a mastectomy, but Medicare part B and my Medigap supplemental paid for all my treatment minus the deductible. If you register on mymedicare.gov I think you can email a question. By phone 1-800-633-4227. From what I have read especially if you can keep it to an outpatient procedure it is covered. Your doctor has to say it is medically needed.

Dx 11/15/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR-, HER2- Dx DCIS, Left, <1cm, Stage 0, Grade 1, 0/1 nodes Radiation Therapy Whole-breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Left
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Oct 23, 2020 05:38PM MinusTwo wrote:

Yes - I had a bilateral mastectomy when only one breast was diagnosed with DCIS.

My "traditional" medicare paid for everything - no question - and my medigap policy picked up the 20%. I paid only the yearly hospital deductible. It's my belief that the 2nd breast does NOT have to be "medically necessary". Mine was certainly not. (although they did find things in that breast once they removed it) You can opt for removal of the 2nd breast for symmetry. I believe your breast surgeon is correct.

I did NOT have an outpatient procedure. My PS took over from the BS in the surgical suite & placed TEs after she was through. I was scheduled to spend at least one night in the hospital. I actually spent two nights because I had problems coming out of the anesthesia in ICU.

BTW - I was at a major medical center.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Oct 23, 2020 05:49PM vifl wrote:

Thanks so much. My Dr just called and said Medicare said there would be no prior authorization needed for the procedure so it should be fully covered! Yay!

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Oct 24, 2020 09:30AM - edited Oct 24, 2020 09:46AM by flashlight

Wonderful news!! It never hurts to find out what is covered. Check all your claims before paying for anything. Sending best wishes....

Dx 11/15/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR-, HER2- Dx DCIS, Left, <1cm, Stage 0, Grade 1, 0/1 nodes Radiation Therapy Whole-breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lumpectomy: Left
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Oct 24, 2020 05:51PM MinusTwo wrote:

Boy that's for sure Flashlight!!! Seems hospitals & docs always bill you some darn thing. 99.9% of the time you won't owe a thing so don't start writing checks. It's often because the provider coded the bill to medicare incorrectly.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014

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