Medicare Payment for Bi-Lateral Masectomy? Help!

Thank you for weighing in, exbrnxgrl. I neglected to mention that I have fibromyalgia and am severely and permanently disabled based on SSI disability board in my state. I am also a single woman living on SSDI. I frankly cannot afford radiation therapy, and it will be very difficult for me to pay for a series of breast surgeries. The fact that the surgeon took a great deal of tissue and still did not achieve clean margin is troubling. I know that some people are in a hurry to get the problem off their chest, LOL, but in my case, I have many health and social factors working against me. I also suffer from crippling anxiety that the SSI disability board said was a factor that kept me from being able to work full time. The anxiety has turned into a full blown panic disorder in the last couple of years. I read somewhere that anxiety itself is a factor also in the insurance compay's decision to approve a bi-lateral masectomy. I am getting ready to try low dose naltrexone (LDN) for the fibromyalgia, and there is a possiblity that it may ease my fibromyalgia enough to improve my quality of life. However, the anxiety is here to stay. Nobody has ever found a cure for anxiety, and it can only be managed by medications. So, I would say that my interest in having a BMX is also related to high anxiety levels.Like some other women, I would like to get this problem off my chest and move on to achieve the best health possible. However, it still might be wise to have one breast removed, which the surgeon's nurse said would be covered by Medicare, and monitor the other closely. The fact that the surgeon's nurse readily said that Medicare would cover the procedure suggests that the pathology report was not good, but I have not even seen it yet. I did not know until I went through the needle exicisional biopsy that the DCIS is invisible and that nobody can tell where it starts and ends from the diagnostic imaging. Nobody tells you that when you start this confusing process.

Hi, WinningSoFa…,

I think your list of trials and tribulations far exceeds mine! Congratulations for surviving and maintaining a sense of humanity. I was exposed to high doses of dietylstilbesterol (DES) in the womb. DES was a hormone given to women at high risk for miscarriage in the 1950s. My mother started to bleed when she was pregnant with me. At some point, she ended up in a hospital in Florida where they pumped her full of DES intended supposedly to stop her from having a miscarriage. She got a huge dose of hormones, and I got a bath of the same hormones in the womb. That is most likely why she got breast cancer, as women who took DES are I believe at higher risk for breast cancer. I am not sure about their daughters, but I never felt very good in my entire life, and I pushed myself through a great deal of advanced education and a high powered career despite having low energy and feeling poorly. Medicare pays for surgery and radiation, but the co-pays add up. As I mentioned, I Iive out in the country. I don't drive, and I get exhausted easily from the fibromyalgia. I really don't want radiation because it will be a trial for me to go to radiation for six weeks, and I don't want to take tamoxifen. I already take some medications daily, although I am waiting to hear that the doctors want me to stop the female hormones (progesterone and estradial). I called the surgeon's nurse a week ago and asked her to discuss my female hormones with the surgeon, but haven't heard anything. I am going to be crying the blues when the doctors tell me to stop the hormones, and I am frankly surprised that they haven't already told me to throw them down the drain. In any case, I am probably getting close to $800 or maybe more in Medicare co-pays for mammograms, ultrasound, stereoscopic biopsy, outpatient hospitalization services, and the surgeon's modest fee for the needle excisional biopsy that lasted two hours. I don't have supplemental insurance because I am disabled under 65 and supplemental is expensive. What I already owe does not include the next surgery planned for the end of the coming week. Ouch. The surgeon's nurse already told me Medicare will pay for a single masectomy of the affected breast, and perhaps I should go with that option.I can always have the other breast removed later if it worries me too much, I guess. I don't like the idea of the sentinel node biopsy which I just learned about on this site. However, my mother did not have any problems with lymphedema, and the statistics suggest that only five to 10 percent of women will develop lymphedema. I guess I should have the genetic testing, but nobody so far has mentioned the idea to me. We don't know of any ancestors who were Ashkenazi Jews, but we are descended from several very wealthy families from Pennsulvania who may have hidden their Jewish origins. Oh, for the money they had! Breast cancer, however, has no respect for money and status, does it? I cannot for the life of me figure out how Jackie Collins, who was wealthy beyond belief, died from breast cancer. Or why my mother's oncolologist, who has access to the best medical care money can buy, had a heart attack, as I don't think he is even 50 years old. Sorry, I guess I got off the point here, but I guess it relieves anxiety to ramble on and on.

Hmmm...I guess I should move to the DCIS forum. I still think that I am at high risk due to the DES exposure that placed my mother at high risk. And, in fact, I do seem to be at high risk since I have developed DCIS at age 60, and my mother has breast cancer. Maybe I don't understand the high risk definition. Anyway, I appreciate the very helpful comments on this forum. I read through the info written by a member on the DCIS forum and it was very illuminating. I think I have a headache now. The surgeons have scheduled me for this coming Friday. That is two surgeries in three weeks with the diagnosis for DCIS coming five days after the needle excisional biopsy. Nobody has told me why the surgeon is in such a hurry.

So, I will move this discussion to DCIS.