Posted on: May 7, 2019 10:30AM - edited May 8, 2019 02:01PM by Moderators
Did you have financial (insurance) issues/barriers trying to get breast reconstruction? e.g. under-insured, couldn't afford? If so, we'd really like to hear your story, and what you may have done to overcome it.
If you feel comfortable, PM your contact information and we'll get in touch with you. Otherwise, please let us hear your story here.
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Posts 1 - 28 (28 total)
May 14, 2019 09:52AM TWills wrote:
I'll share, I'm on my 4th year of treatment and reconstruction so that means 4 years of very high out of pocket deductibles and copays, $9000 each year plus my loss of income. It has affected us tremendously financially,our retirement plan will have to be revised and most likely have to downsize our home. I had no idea how complicated it would be and how timing with Dr's and surgeries could get so drug out. It's devestating and feels never ending.
May 16, 2019 03:31PM TWills wrote:
No I didn’t, I’m pretty sure I’m in the same situation as most. I fall into that middle category that typically would get much help. But who knows.
May 16, 2019 03:42PM Meow13 wrote:
Twills, I was also thinking about getting tax credit for spending so much on medical. It might be worth looking into, but tax laws changed so much. Also have you looked into other healthcare plans? I know it varies by state my aunt in New York was able to get much better plan after Obamacare. She pays alot less now. I think Texas is bad for healthcare I was talking with someone and found they pay so much more for the same plans in Washington state with 3x the deductible. Not sure about Florida.
May 16, 2019 03:47PM - edited May 16, 2019 03:49PM by TWills
I'm pretty sure the out of pocket expenses are our own fault, I beleive we actually chose it:/ Husband works for a very large company and we have BCBS so you'd think it would be a bit better. He looked into the tax credit and I’m notsure how that worked out, I’ll ask.
May 16, 2019 03:58PM Meow13 wrote:
I have BCBS also I had my DIEP expensive surgery in 2012 at that time just had $10 copays and no deductible 100% coverage, now I think it is $2300 out of pocket per person maximum a year, $300 a person deductible, they pay 90% we pay 10% until the $2300 is reached then it is 100%. I miss the old plan we had it so good all those years. My son just had foot surgery we just paid $2300 and insurance paid the rest. I asked my husband about tax deductions now the standard deduction is higher 12k so we just do the straight forward standard.
Jun 3, 2019 09:42PM Gramto4 wrote:
I’m in the same situation. I had a mastectomy on my right breast in April 2018 with tissue expander placed at that time. In September of 2018 they exchanged the tissue expander with an implant. During the same surgery, they did a reduction and lift on my natural left breast. This surgery cost me my deductible of $1,500.00 and my total out pocket maximum which is $4000.00 so a total of $5,500.00. Dr said I had to wait 9 months for the results to know the full results as far as symmetry. It’s Now June 2019and my plastic surgeon says I need surgery for revisions and to replace what I have with a smaller implant . I will now have to pay my deductible and out of pocket maximum before insurance will pay and they still only pay 70%. Im afraid that it may take a few surgeries before we achieve a good match and each calendar year means I have to start over with deductibles and out of pocket maximums. I feel forced to settle with breasts that are less than desirable because of the expense of another surgery.
Sep 17, 2019 01:08AM macb04 wrote:
I had 17 procedures between 2012 to 2014/2015. First one where they chopped me up, then endlessly trying to fix things, overcome surgeon errors. Thousands, and thousands out of pocket. My savings are gone. I am not even completely symmetrical, never look at myself nude again.
I tried to itemize. We made just a hair too much. One year I had kept receipts for everything, $13,000 ( yes that says thirteen thousand dollars) out of pocket one year which counted for nothing. Our government has it sewn up so badly that even catastrophic medical expenses are not able to be claimed. That is ridiculous, just insane. It's not like my medical expenses were for elective procedures. I just wanted to feel close to human.
Sep 17, 2019 07:29PM Meow13 wrote:
I miss my old insurance although I can't complain too much 2300 a year is the max out of pocket. I am very careful to choose my treatment options carefully. Macb04 I wish you could sue your doctor at SCCA for all the pain and suffering, 17 procedures to fix things UGH.
Sep 18, 2019 10:09PM - edited Sep 18, 2019 10:09PM by macb04
Thanks Meow. Yes, I was royally screwed over by repeat incompetence at scca and a couple of other PSs. I looked into suing, but there was a window of time that was missed because I was sick and exhausted like most being tortured by the bc industry.
Sep 19, 2019 06:01AM Brilee76 wrote:
I have BCBS of SC. They covered anything that was deemed medically necessary. They have an exception for cranial prosthesis though so they will not pay anything toward a wig should you need chemotherapy. I did have to reach my deductible and out of pocket max before it fully covered everything which is $7,350 and I am still paying on that. It was explained to me that if an insurance company covers the mastectomy they must also cover reconstruction. I was also told that if I left my job which I have my insurance through and started a job with a different company whose insurance also covers mastectomy that the new insurance company would have to cover any part of my treatment even though they weren't the insurance company that covered the mastectomy. It was also explained to me that if I feel I'm unable to work during treatment and need to leave my job that I would most likely qualify for medicaid which would pick up any treatments that are a part of my treatment plan including reconstruction. All of this was explained to me by my navigator. My insurance renews December 1st and if God will help me stay working I'm going to see about a plan with a lower out of pocket max this coming year.
Oct 7, 2019 09:17PM macb04 wrote:
BCBS only covered some things. Between the high deductible and the other ton of things they didn't cover I have run through my retirement money, and will have to keep working for as long as I am able.
The Cancer Industry knowingly impoverished me and millions of others. Think of all those CEO's just rolling in the dough. Well when they die, they can't take it with them. Especially not where they are likely going.....
Oct 21, 2019 09:52AM Danraine19 wrote:
I have had two ruptured breast implants done on my right side, had to pay out of pocket for both, now my left one is almost gone and I can't get approved for a loan to have them both replaced. I am in so much pain, I'm uncomfortable, and have no health insurance because it's too expensive. What can I do, how can I go on in this much pain. I have the mentor round rough shell implants. Please help!
Oct 21, 2019 11:07AM Moderators wrote:
Welcome to the BCO community. We are sorry that you find yourself here with these concerns. We hope others will chime in with their experiences. Check out this link to Paying for your Care on our Main Site. Be sure to check in with your treatment facility for possible financial help and payment programs. Keep us posted and let us know how we can help you to navigate your way around here.
Oct 22, 2019 02:45PM edwards750 wrote:
Financial pressures from this insidious disease is off the chart. We have BC/BS of Tenn and our deductible is $5k. We reached that in 3 months. Thank goodness because 33 radiation treatments came after surgery which was covered at 100%.
Danraine - were you declined for financial help because your Credit score wasn’t high enough? Unfortunately the fact you don’t have health insurance probably contributed to that decision. Fair - definitely not but it’s all about the almighty dollar.
There has to be someone either a patient advocate or social worker at your hospital who can help you. I had a patient advocate who was awesome. I wish all this hoopla about BC awareness focused more on the financial issues associated with this disease.
Nov 11, 2019 09:04PM Lrazze wrote:
I also live in the Clearwater Area. I had a double mastectomy breast cancer, gene positive almost 2 years to the date. Implants were put in immediately. Three weeks after surgery had infection on left side. Spent a few days in hospital on antibiotic drip and it cleared up.
Implants are under muscle and I have never felt comfortable. In 2 days I have an appointment with a plastic surgeon in Tampa to discuss other options because I am so uncomfortable with the implants under muscle.
Low and behold, as I got out of shower today I noticed a round circular red mark on my left breast and it is becoming painful and is hot to the touch.
I am very nervous about the infection. I am considering a flap. TWills in Clearwater, can you share with me
your experience with the flap????? I would greatly appreciate it. I don't even know what doctor to go to. I do
not want to go back to the Plastic surgeon I had in Clearwater. I was not happy the Doctor.
Nov 12, 2019 07:39AM Moderators wrote:
Lrazze, we're sorry you had to join us, but welcome! We're sure someone will be along shortly who can weigh in with similar experiences and advice. In the mean time, just in case Twills doesn't see your post, you can send her a private message. For that, click on her username, and under the information at the top, you'll see the option to "send a private message". Sometimes it's easier to connect with other members this way!
We hope this helps. Looking forward to hearing more from you soon!
Jan 12, 2020 08:36AM Gramto4 wrote:
Hi everyone. I’m also dealing with frustration about insurance deductible and out of pocket expense. Three surgeries in 2018 which cost me $5,500 out of pocket. One surgery in August of 2019 which again cost my out of pocket of $5,500 and I am still paying for monthly. Now it’s January of 2020 and the implant that was put in last August has flipped over in the breast pocket. I will need to have another revision surgery to correct this so that will cost me another out of pocket expense of $5,500.
I think it’s very wrong that a woman dealing with breast reconstruction has to meet the deductible and out of pocket expense each year when the surgeries being done are all related to her initial diagnosis of Breast cancer and the surgeries are not elective- they are necessary. There are time limits as to when reconstruction can be done and just because they fall into a new calendar year, the insurance companies should not be able to reap the benefit. I’m seriously thinking of just dealing with the unsightly look and discomfort of living with the flipped over implant just so I won’t have to add the burden of another $5,500 to my husband and I. My husband is turning 65 this April and we would both like to have him be able to retire but with all these medical cost, he’s going to have to keep working longer. My husband is a cancer survivor himself- he was diagnosed with Non-Hodgkin Lymphoma in 2009 and we just celebrated his 10yr cancer free anniversary last summer for which we are truly grateful and feel blessed. We have certainly paid our share of medical cost over the years and now my breast cancer is sure to put more financial strain on us as we are both approaching our so called “Golden Years”
May 18, 2020 05:05AM Aftonfog wrote:
Paying for mastectomy and reconstruction is a daunting idea. I have $180 left to pay of my $1000 deductible, and my out of pocket maximum is $5,000. I am expecting to fork over $5,200 for the surgery scheduled at the end of June. I am planning on speaking with the surgery admin my my PS office about the insurance process. Right now I am looking at BMX with only nipple reconstruction, but doctors can charge anywhere from $7000-$50000 for their part in the surgery.
my coinsurance is 20% - it would be amazing if the surgery cost less than 25k so I don’t have to pay my full out of pocket maximum. But throw in a night in the hospital, and the charges just pile on. I have BCBS of VA
Oct 15, 2020 05:48PM julz4 wrote:
Hi Everyone, I finally came to some peaceful decisions as I have had enough & I want a double mastectomy. I just had my 5th biopsy in my left breast. First biopsy since BC 8 years ago. I pay out $3,000 to $5,000 out of pocket ever year for the past 6 years as I have a BRCA 2 variant. I’m seen twice a year just had my yearly MRI & they saw something & I needed a MRI guided biopsy. It through me for a loop. I’m just getting into a groove after having Thyroid Cancer 2 yrs & 8 months ago. But I’m done the thought of doing this for the next 20 + years is down right daunting. So I have put into motion to see what it is going to entail. I go to John Hopkins & have my first 2 appointments November 2 & 3. I start with a brand new insurance on November 1st through work. I may have to wait a year as I only have 5 1/2 weeks of PTO & sick leave combined. We have a special fund from work that I can have 4 weeks of catastrophe leave pay if I qualify. Also I could end up paying $12,000 out of pocket for my deductible before I reach 100% paid. I don’t have that at all. Even if I only had the mastectomies & no recon. Makes me mad as I just was feeling peace with my decision.
Oct 15, 2020 09:35PM Maryjv wrote:
julz4-I have had 2 surgeries this year (mastectomy and delayed reconstruction with DIEP flap) and had to be out of work a total of 14 weeks...I used short term disability which paid 75% of my pay during that time (I did have to use 40 hours PTO before the std kicked in) and i was able to use a little pto to get my pay to 100%! I’m sure your company has to offer this as well!! Also, is it possible to look at a different medical plan through work for the upcoming year since you know you will be having surgery? I was diagnosed with cancer in November 2019, so during open enrollment I made sure to select the low deductible option because I knew i was going to meet that quickly with treatment! Thank you for sharing your experience with scares since your partial mastectomy-I am such a worrier and I knew it would be too much to have to keep going for scans and possible Biopsies! Please keep us posted on how you are doing!
Oct 18, 2020 08:16PM soccermom wrote:
I'm 68. My last reconstruction was 2005 ( a re-do of 2004 reconstruction). Now I may have a ruptured implant, so may be looking at another one. MRI in 2 weeks to find out for sure.
My symmetry was originally pretty good after the 2005 surgery, but over the past 5 years has gotten worse, so honestly I was interested in a 3rd reconstruction anyhow. Which will now be a must if there is a rupture. (I had to have brain surgery in 2019 to remove a meningioma. Now recovered from that and find out maybe need another reconstruction surgery. )
Now I'm on Medicare with a Health Net supplement. Many PS in my area (southern California) don't even take insurance! Not looking forward to finding out how expensive it will be.
Anyone with PS recommendations that take Medicare in California? I live in North San Diego and my daughter lives in the Bay area, so will travel if necessary. Interested in flap reconstruction. I may live another 20 years and don't want to go through this again.
Oct 18, 2020 08:28PM Moderators wrote:
soccermom, we're so sorry to hear what you're going through. To find a surgeon who covers your additional procedure, you may want to also call the Cancer Information Service (CIS) at 1-800-4-CANCER. They're with the National Cancer Institute. Hopefully with your insurance you should get this covered!
Oct 18, 2020 10:51PM julz4 wrote:
Maryjv, thank you for responding. I am paying a higher amount for the lowest deductible. The $12,000 is worst case scenario. It may only end up costing me 4,000 & $6,000. It depends on what the oncology surgeons accepts for surgery if he is on the higher tier then I’m good. If he only accepts the standard tier then it will be higher. I’m trying not to worry & hope that this all works out for the best! What’s meant to be will be. COVID has put a big cut in our families money this year & we have lost a lot of jobs as my Husband does DJing as a side job. I know we are not the only ones hurting. Again Thank You & I will keep you posted!
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