Insurance and Reconstruction

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  • foreverchanged
    foreverchanged Member Posts: 63
    edited January 2013

    I had my surgery in NJ too, plastic surgeon billed $9900, got paid just under $3000 as in network rate for bilateral tissue expander placement. 

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  • ablydec
    ablydec Member Posts: 124
    edited January 2013

    I assumed this was common.  They charge a large amount (12,000) for reconstructive surgery in the first place, but not double that for bilateral.  I didn't ask more specifically, because it didn't seem surprising.  Buying health insurance for a family of four is not four times the price of one.  Something like that?

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  • barberchic
    barberchic Member Posts: 56
    edited January 2013

    I was recently diagnosed, as of now i'm waiting for approval for medicaid! Not sure if i'll have to end up having a mastectomy or not? Of course i'm giving it alot of thought because I really want it all gone!!! My question is, does anyone on here have medicaid ins ? If so, will they pay for reconstruction?

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  • jacee
    jacee Member Posts: 1,384
    edited January 2013

    barbercic...I'm sorry for your diagnosis. You will find much help here so stick around. From what I can tell, Medicare is not bound by the Federal mandate of the Women's Heath And Cancer Rights Act. So they are not required to provide reconstruction. However, there may be a state law in your state that will require coverage. You might check with your local hospital and see if they have a breast care navigator, or even the insurance dept. there should be able to tell you. They must deal with this frequently. Best wishes to you.

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  • Chickadee
    Chickadee Member Posts: 4,467
    edited January 2013



    http://www.cancer.org/treatment/findingandpayingfortreatment/managinginsuranceissues/womens-health-and-cancer-rights-act



    Do the WHCRA requirements apply to Medicare or Medicaid?



    No. The law does not apply to Medicare and Medicaid.



    Still, Medicare covers breast reconstruction if you had a mastectomy because of breast cancer. Medicaid coverage varies in each state, so you will have to get this information for your state. (See the section called “To learn more” for contact information.)

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  • barberchic
    barberchic Member Posts: 56
    edited January 2013

    Thank you ladies! Yes, I will stay connected to thus site, it keeps my mind busy, on the positive side of bc rather than the negative! Thanks again for the info and I will post back as soon as I find out! It nay help others in my situation :)

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  • Golden01
    Golden01 Member Posts: 916
    edited March 2013

    Here's a story of how things turned around once a BC patient contacted a local TV station when her insurance wouldn't cover a portion of her reconstruction surgery.Her appeal with the insurance company had not been settled but the hospital had turned the bill over to a collection agency.  Here's the link to the article in today's Arizona Republic:

    After cancer battle ends, a financial battle begins

    http://www.azcentral.com/business/call12foraction/articles/20130301after-cancer-battle-ends-financial-battle-begins.html?nclick_check=1

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