How do you deal with your significant other?

TeriR

I am 48 and was just diagnosed with DCIS in one breast only (right now at least) and I am considering prophylactic removal of the other due to an extremely high family history (which includes my father and his brother) of breast cancer.  It's a hard enough decision and my insurance certainly doesn't make it any easier.  But my husband has just blurted out the comment, "how much is that going to cost if insurance doesn't pay".  Wow! Talk about depression... Has anyone else experienced this?  Or has anyone else had a prophylactic removal covered by their insurance?  I would be extremely grateful for any advice. 

SpecialK

TeriR - I was a lumpectomy candidate but opted for bi-lat mastectomy which was covered by insurance.  Post-op pathology indicated that it was not strictly "prophy" because they did find ADH/ALH on that side, but that was not known until afterward.  All reconstruction has also been covered by insurance, which is dictated by law.  My insurance has a referral system in place so my doctors know in advance what will be covered.  Your doctor can ask for a pre-treatment estimate from your insurance so you should know exactly what will, or will not, be covered, and what your out-of-pocket expense will be with deductibles and co-pays.  If you have concerns about costs this might be the best way to have no surprise bills.  Good luck!

3monstmama

many (((hugs))).  As already noted, reconstruction is covered.  i would imagine that given the family history you have described, your insurance carrier will not be too balky.  In december I had a prophy job on my ovaries and fallopian tubes after my mother was diagnosed with ovarian cancer.  Not a peep from insurance.  They know its a damn site cheaper to yank my ovaries now than to pay for cancer treatment in the future.

As for your husband, deep breathe.  You know him better than I but I can analyze from what ithe situation would be were it my own DH.  While his phrasing, uhhh, well, stinks, perhaps he's just worried at how to take care of you?  Our society still gives men the message that they must take care of their spouses and at times like this I think men often revert to stereotype.  so its not really the spending of the money that is impacting him, its the taking care of you.  I have to say, I know another man who had to pay the insurance on his wife having knee replacement.  He talks alot about what it is costing him and if you weren't around him a lot you might think he resents the money.  But if you stand around a while and listen, he also talks about how great it is that his wife is no longer in pain and how hard it is for him not to yell "I TOLD YOU SO!!" because he'd been trying to get her to do the surgery for years.

does that make any sense?  more hugs.

lea33

Just had a Bilateral mastectomy. DCIS in left breast and right breast was covered by insurance. Reconstruction is covered by law.

TeriR

Lea33 was your rt breast a prop?

TeriR

Thank you so much.  I was really shocked at my husb response, especially since 5 min before he was telling me he'd support any decision I make.  Talk about a roller coaster.  I have a really big appreciation for all women that go through this now.  You've got to balance home, doctors, insurance, and make some really BIG decisions.  OMG it's amazing more of us aren't crazy:-)

TeriR

SpecialK, did you go into surgery without knowing whether or not the "prophy" would be covered?

SpecialK

TeriR - No, I knew that my insurance would cover.  Most docs/hospitals will not proceed unless they know where the payment will be coming from.  That is why I recommended for you to seek a pre-treatment estimate from your insurance - that way you will know in advance what they will cover.  With your family history I would be surprised if they would refuse a BMX.  Also, as I said, I assumed that the left breast was prophy - the ADH/ALH was not seen on MRI prior to surgery, this was discovered after the surgery, so the insurance company assumed this was really a prophy removal.

On the subject of your husband - it is possible that his financial concern is out of wanting you to have the best care and being worried how it can be provided if your insurance will not cover the prophy mx?  Maybe it just came out wrong?  I want to give him the benefit of the doubt if he had stated previously that he would support whatever you wanted.