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Topic: LVA cost & coverage

Forum: Lymphedema —

Talk with other about how to lower your risk of lymphedema and how to manage it if you've been diagnosed.

Posted on: Jan 10, 2019 08:53PM

elise24601 wrote:

For those who have had this done, were you able to get insurance coverage or not? And if not what was the total out of pocket cost? (I’m referring to the bypass not the nodal transfer procedure)

I have blue cross blue shield and they are waiving prior auth and saying it’s covered according to the coding from my PS,but will not send me anything in writing to assure me they will pay for it.

Dx 5/4/2016, IDC, Left, 4cm, Stage IIIC, Grade 3, 15/28 nodes, ER+/PR+, HER2- Surgery Mastectomy; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Radiation Therapy Whole-breast: Breast, Lymph nodes, Chest wall Chemotherapy Cytoxan (cyclophosphamide), Taxotere (docetaxel) Chemotherapy Xeloda (capecitabine)
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May 31, 2021 02:31PM MandaLynn wrote:

hi, I have BCBS and am getting the same run around. Did you ever get this figured out?

Amanda Dx 10/20/2008, ILC, 3cm, Stage IIIA, Grade 2, 4/17 nodes, ER+/PR+, HER2-
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Jun 1, 2021 08:54AM exbrnxgrl wrote:

mandalynn,

The op has not signed into bco for over two years. I hope someone else can answer your question.

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur Dx 7/8/2011, IDC, Left, 4cm, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Surgery 9/7/2011 Lymph node removal: Left; Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Dx 11/2011, IDC, Left, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2- Hormonal Therapy 11/21/2011 Arimidex (anastrozole) Radiation Therapy 11/21/2011 Bone Hormonal Therapy 6/19/2014 Femara (letrozole) Hormonal Therapy Aromasin (exemestane)
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Aug 19, 2021 03:27PM KaraInLA wrote:

MandaLynn, I hope you are still checking this site. I have Blue Shield CA, and had no trouble with insurance, although I had Anthem BC when I started and was denied. I had the help of an attorney and a professional medical researcher and appealed through the state Dept of Managed Care and won the appeal, then my office changed insurance before I could have the surgery. I think the decision from the department is public so it should help others with their appeals.

Good luck.

Dx 3/2007, IDC, Left, Stage IIB, 0/3 nodes, ER+, HER2- Dx 6/2020, IDC, Left, 2cm, Stage IB, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 8/20/2020 Mastectomy: Left; Reconstruction (left): Stacked/hybrid GAP flap Hormonal Therapy

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