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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 09:30AM - edited May 8, 2019 01:01PM 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 01:02PM - edited May 10, 2019 07:12AM by Moderators

Bump.

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May 13, 2019 01:54PM Moderators wrote:

Bumping again, just in case.

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May 14, 2019 08:52AM 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 3/2/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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May 16, 2019 02:20PM 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 02:31PM 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 3/2/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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May 16, 2019 02:42PM 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 02:47PM - edited May 16, 2019 02:49PM 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 3/2/2018 Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap
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May 16, 2019 02:58PM 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 08:42PM 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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