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Topic: Financial barriers to getting reconstruction?

Forum: Breast Reconstruction — Is it right for you? Discuss timing and various procedures and techniques.

Posted on: May 7, 2019 07:30AM - edited May 8, 2019 11:01AM by Moderators

Moderators wrote:

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.

Thank you for sharing! I

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May 8, 2019 11:02AM - edited May 10, 2019 05:12AM by Moderators

Bump.

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May 13, 2019 11:54AM Moderators wrote:

Bumping again, just in case.

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May 14, 2019 06:52AM 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.

Dx 11/2016, IDC, Left, 4cm, Stage IIB, Grade 3, 1/14 nodes, ER+/PR+, HER2- Surgery 12/12/2016 Lymph node removal: Left, Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic mastectomy: Right Chemotherapy 2/2/2017 AC + T (Taxol) Surgery 7/9/2017 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Radiation Therapy 7/30/2017 Whole-breast: Breast, Chest wall Surgery 8/27/2017 Hormonal Therapy 11/8/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 3/1/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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May 16, 2019 12:20PM Moderators wrote:

TWills, we are really so sorry to read that this has happened to you. Have you spoken with your treatment facility to see if there would be any financial help?


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May 16, 2019 12:31PM 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.

Dx 11/2016, IDC, Left, 4cm, Stage IIB, Grade 3, 1/14 nodes, ER+/PR+, HER2- Surgery 12/12/2016 Lymph node removal: Left, Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic mastectomy: Right Chemotherapy 2/2/2017 AC + T (Taxol) Surgery 7/9/2017 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Radiation Therapy 7/30/2017 Whole-breast: Breast, Chest wall Surgery 8/27/2017 Hormonal Therapy 11/8/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 3/1/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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May 16, 2019 12:42PM 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.

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May 16, 2019 12:47PM - edited May 16, 2019 12:49PM 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.

Dx 11/2016, IDC, Left, 4cm, Stage IIB, Grade 3, 1/14 nodes, ER+/PR+, HER2- Surgery 12/12/2016 Lymph node removal: Left, Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic mastectomy: Right Chemotherapy 2/2/2017 AC + T (Taxol) Surgery 7/9/2017 Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Radiation Therapy 7/30/2017 Whole-breast: Breast, Chest wall Surgery 8/27/2017 Hormonal Therapy 11/8/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 3/1/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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May 16, 2019 12:58PM 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.

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Jun 3, 2019 06:42PM Gramto4 wrote:

TWills,

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.

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Sep 16, 2019 10:08PM 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.

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Sep 17, 2019 04:29PM 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.

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Sep 18, 2019 07:09PM - edited Sep 18, 2019 07:09PM 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.

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Sep 19, 2019 03:01AM 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.

~Bridget Dx 5/16/2019, ILC, Left, 3cm, Stage IB, Grade 2, 1/3 nodes, ER+/PR+, HER2- Hormonal Therapy 7/1/2019 Hormonal Therapy 7/1/2019 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 8/6/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Chemotherapy 9/18/2019 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/16/2019 Femara (letrozole) Hormonal Therapy 12/30/2019 Surgery 1/20/2020 Prophylactic ovary removal
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Oct 7, 2019 06:17PM 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.....

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Oct 21, 2019 06:52AM 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!


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Oct 21, 2019 06:55AM Danraine19 wrote:

I have a 680 credit score and I can't get financing! I need to get this done quickly.

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Oct 21, 2019 08:07AM Moderators wrote:

Dear Danraine19,

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.

The Mods

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Oct 22, 2019 11:45AM 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.

Good luck!

Diane

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Nov 11, 2019 06:04PM 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.


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Nov 12, 2019 04:39AM 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!

The Mods

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