Topic: Does insurance pay for redo's & future maintenance

Forum: Breast Reconstruction — Talk with others facing decisions about whether or not to have breast reconstruction, and if so, what type and when.

Posted on: Aug 20, 2007 05:31PM

Posted on: Aug 20, 2007 05:31PM

rapidash wrote:

Will most insurance cover revisions for implant/expander surgery? Will it cover replacement of implants ten years down the road? (Boy, isn't that some optimism for a stage 3 gal!!!! ) I had a lat flap and proph. mastectomy on 6/07. Thanks for any info!! Log in to post a reply

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Aug 20, 2007 08:14PM iodine wrote:

I don't know about 10 years down the road. My ins paid for my complete redo 1 year after my first recon.

Dotti---BE NOT AFRAID, Pope John Paul
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Aug 21, 2007 07:01AM sharebear wrote:

In Michigan insurance companies are required by law to cover any reconstruction issues pertaining to breast cancer. I had radiation after a lumpectomy and years later that breast had shrunk is size about 40% which can happen after radiation. The insurance company paid for an implant in the radiated side and a reduction on the good size in order to create symetry. All in all it took about 3 reconstructions and implant swaps to fix everything. My breasts were so dense when I was diagnosed and the natural progression of getting older plus the radiation made it necessary to exchange the implants a few times for symetry. The first one capsulized which is why we decided to do the reduction and go for a smaller implant.

Now they are both gone and the implants have been replaced with stomach muscles from a tram! Amazing! They are more symetrical now than they have every been.

Sharon
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Aug 21, 2007 10:11AM Fit999 wrote:

There was a national act passed in 1998 that requires any insurance company that covers mastectomies to cover all surgeries required for symmetry. My GS said that insurance will also cover me in the future when my natural boob sags and the implant is still high and perky. One funny thing, during my first post op checkup w/my PS she handed me the warranty card for the implant. She said since it was cancer related it�s a lifetime warranty. I read the fine print and the warranty only pertains if the implant breaks. And the manufacturer will pay up to a certain amount toward the surgery required to replace the broken implant, but the new implant would be free. Hopefully none of us will ever have to walk that road, but its good to know all the facts.

Issa
hugs, Issa Dx 12/22/2006, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER-/PR-, HER2+
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Aug 21, 2007 10:15AM Fit999 wrote:

Dotti,

If I may ask, why did you need a redo? Ive had 4 surgeries in 7 months, I dont particulary want anymore. Im thinking by the time my natural boob sags, I wont care.

Thanks,
Issa
hugs, Issa Dx 12/22/2006, IDC, 1cm, Stage I, Grade 3, 0/2 nodes, ER-/PR-, HER2+
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Aug 21, 2007 12:36PM rapidash wrote:

Oh, I don't need a redo now! I was just wondering about later down the road

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Aug 21, 2007 12:55PM iodine wrote:

My first outcome was awful. The expander was encapsulated and never fully expanded but the ps would not admit it. I was a wuss and did't fight him, I also didn't pick him. He said he could fix everything with the exchange. The implant was under my arm, below the inframammy fold and 2 cups Smaller. He also "lifted" my good boob and made it a cup smaller to gain "symmentry".
He then denied that I was smaller and stated that he had obtainded great symmentry and was delighted with the results. He also lied to me stating that there was nothing more to do, and even there was, insurance would not cover it.

I then thought it over and let it all settle for about 3 months. Grew a spine, got a second, then third, then 4th opinion. Found a ps who actually looked me in the eye and addressed MY concerns. We took it all out and he found that I'd had a huge seroma on my mast side that had to be debrieded, a poor pocket, and then used lipo to give me an inframammary fold.
He augmented the good boob, lipoed the sides of my chest, sutured the expander/implant in place to prevent movement and I have a good outcome.
It was one of those times that when I found this doc, I was able to exhale. I didn't feel the need to second guess, reseach everything he recommended, I just did what he told me to do. I TRUSTED him. What a relief after 2 years of pins and needles.
Dotti---BE NOT AFRAID, Pope John Paul
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Aug 21, 2007 03:13PM GoodMommy wrote:

I have a question re. insurance and hope someone can answer. I'm currently with UHC through my husband's employer (he's retired). My husband is 9 years older than me and will be medicare eligible in November. In order for me to keep my insurance, he has to buy a medicare supplement offered by UHC from his former employer. This is a rip-off because he will have to pay 2 1/2 times what he could get the insurance for on the open market. I can change to a different policy through his employer because there is no pre-existing condition clause. My question, I still have to go through the exchange and nipple reconstruction. Would that be covered by a different insurance company and also would the BC be considered a pre-existing condition if God forbids, there is a recurrence?

Dx 3/2005, IDC, 1cm, Stage IIIA, Grade 3, 15/20 nodes, ER+/PR+, HER2-
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Aug 22, 2007 09:42AM slanderson wrote:

My moms insurance paid for her redo 29 years down the road.

Shannon
Shannon Dx 7/13/2005, IDC, 1cm, Stage I, Grade 3, ER-/PR-, HER2-
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Aug 22, 2007 10:01AM sharebear wrote:

I only know what is true in Michigan. I have changed insurance throught the years and through my reconstructions. We have a law that states as long as you continually have insurance and do not allow it to lapse, you do not have a pre-existing condition. If that means paying for cobra when changing jobs and waiting for insurance to kick in that that's what I've done and I've always been covered. Just don't ever go without.

Sharon
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Aug 22, 2007 10:02AM GoodMommy wrote:

Shannon,

Had she changed insurance in the 29 years? We are getting down to the wire when we can change through my husbands former employer. I know that I can't get private insurance for 10 years; but I can change to GHP or Mercy Health Care. I'm just hesitant to do anything. They will except me; but I'm afraid that they might come back and say that the cancer or finishing the reconstruction was pre-existing. I would appreciate any information anyone might have.

God bless,

Chris
Dx 3/2005, IDC, 1cm, Stage IIIA, Grade 3, 15/20 nodes, ER+/PR+, HER2-

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