Financial barriers to getting reconstruction?

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.

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.

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.

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.

I miss my old insurance although I can't complain too much 2300 a year is the max out of pocket. I am very careful to choose my treatment options carefully. Macb04 I wish you could sue your doctor at SCCA for all the pain and suffering, 17 procedures to fix things UGH.

I have BCBS of SC. They covered anything that was deemed medically necessary. They have an exception for cranial prosthesis though so they will not pay anything toward a wig should you need chemotherapy. I did have to reach my deductible and out of pocket max before it fully covered everything which is $7,350 and I am still paying on that. It was explained to me that if an insurance company covers the mastectomy they must also cover reconstruction. I was also told that if I left my job which I have my insurance through and started a job with a different company whose insurance also covers mastectomy that the new insurance company would have to cover any part of my treatment even though they weren't the insurance company that covered the mastectomy. It was also explained to me that if I feel I'm unable to work during treatment and need to leave my job that I would most likely qualify for medicaid which would pick up any treatments that are a part of my treatment plan including reconstruction. All of this was explained to me by my navigator. My insurance renews December 1st and if God will help me stay working I'm going to see about a plan with a lower out of pocket max this coming year.

I have had two ruptured breast implants done on my right side, had to pay out of pocket for both, now my left one is almost gone and I can't get approved for a loan to have them both replaced. I am in so much pain, I'm uncomfortable, and have no health insurance because it's too expensive. What can I do, how can I go on in this much pain. I have the mentor round rough shell implants. Please help!

I also live in the Clearwater Area. I had a double mastectomy breast cancer, gene positive almost 2 years to the date. Implants were put in immediately. Three weeks after surgery had infection on left side. Spent a few days in hospital on antibiotic drip and it cleared up.

Implants are under muscle and I have never felt comfortable. In 2 days I have an appointment with a plastic surgeon in Tampa to discuss other options because I am so uncomfortable with the implants under muscle.

Low and behold, as I got out of shower today I noticed a round circular red mark on my left breast and it is becoming painful and is hot to the touch.

I am very nervous about the infection. I am considering a flap. TWills in Clearwater, can you share with me

your experience with the flap????? I would greatly appreciate it. I don't even know what doctor to go to. I do

not want to go back to the Plastic surgeon I had in Clearwater. I was not happy the Doctor.

Hi everyone. I’m also dealing with frustration about insurance deductible and out of pocket expense. Three surgeries in 2018 which cost me $5,500 out of pocket. One surgery in August of 2019 which again cost my out of pocket of $5,500 and I am still paying for monthly. Now it’s January of 2020 and the implant that was put in last August has flipped over in the breast pocket. I will need to have another revision surgery to correct this so that will cost me another out of pocket expense of $5,500.

I think it’s very wrong that a woman dealing with breast reconstruction has to meet the deductible and out of pocket expense each year when the surgeries being done are all related to her initial diagnosis of Breast cancer and the surgeries are not elective- they are necessary. There are time limits as to when reconstruction can be done and just because they fall into a new calendar year, the insurance companies should not be able to reap the benefit. I’m seriously thinking of just dealing with the unsightly look and discomfort of living with the flipped over implant just so I won’t have to add the burden of another $5,500 to my husband and I. My husband is turning 65 this April and we would both like to have him be able to retire but with all these medical cost, he’s going to have to keep working longer. My husband is a cancer survivor himself- he was diagnosed with Non-Hodgkin Lymphoma in 2009 and we just celebrated his 10yr cancer free anniversary last summer for which we are truly grateful and feel blessed. We have certainly paid our share of medical cost over the years and now my breast cancer is sure to put more financial strain on us as we are both approaching our so called “Golden Years”

Hi Everyone, I finally came to some peaceful decisions as I have had enough & I want a double mastectomy. I just had my 5th biopsy in my left breast. First biopsy since BC 8 years ago. I pay out $3,000 to $5,000 out of pocket ever year for the past 6 years as I have a BRCA 2 variant. I’m seen twice a year just had my yearly MRI & they saw something & I needed a MRI guided biopsy. It through me for a loop. I’m just getting into a groove after having Thyroid Cancer 2 yrs & 8 months ago. But I’m done the thought of doing this for the next 20 + years is down right daunting. So I have put into motion to see what it is going to entail. I go to John Hopkins & have my first 2 appointments November 2 & 3. I start with a brand new insurance on November 1st through work. I may have to wait a year as I only have 5 1/2 weeks of PTO & sick leave combined. We have a special fund from work that I can have 4 weeks of catastrophe leave pay if I qualify. Also I could end up paying $12,000 out of pocket for my deductible before I reach 100% paid. I don’t have that at all. Even if I only had the mastectomies & no recon. Makes me mad as I just was feeling peace with my decision.

I'm 68. My last reconstruction was 2005 ( a re-do of 2004 reconstruction). Now I may have a ruptured implant, so may be looking at another one. MRI in 2 weeks to find out for sure.

My symmetry was originally pretty good after the 2005 surgery, but over the past 5 years has gotten worse, so honestly I was interested in a 3rd reconstruction anyhow. Which will now be a must if there is a rupture. (I had to have brain surgery in 2019 to remove a meningioma. Now recovered from that and find out maybe need another reconstruction surgery. )

Now I'm on Medicare with a Health Net supplement. Many PS in my area (southern California) don't even take insurance! Not looking forward to finding out how expensive it will be.

Anyone with PS recommendations that take Medicare in California? I live in North San Diego and my daughter lives in the Bay area, so will travel if necessary. Interested in flap reconstruction. I may live another 20 years and don't want to go through this again.

Thank you ! I will check with them.

I have similar frustrations, and I don't have any solutions for anyone, but I can commiserate. I am, for all intents and purposes, self-employed. I have to buy my own insurance policy, which means no group benefits. I discovered years ago that the cheapest route for me to go was to get the lowest bronze plan offered through ACA because, even if I reach my total out of pocket, which I have for 9 of the last 10 years, the savings on the premium mean that I pay less than if I got a "better" policy. In those 10 years, my total out-of-pocket has gone from about $5,000 annually to more than $8,000 annually, and the monthly premium has nearly doubled. Thankfully, I have had savings to pay my bills, and I was given a grant from Genentech (maker of perjeta and herceptin) for some of my chemotherapy costs, but the expenses of treatment and surgery have been burdensome to say the least.

In any event, my frustration currently is that I had a double mastectomy in January with a delayed diep flap reconstruction, which was supposed to occur in April. Thanks to covid, that surgery was delayed until August. Now I need stage 2 surgery to make my breasts look like each other. Right now, one is about one-third larger than the other and sits lower on my chest then the other. Of course, I cannot have the surgery until after the first of the year, which means another out-of-pocket maximum. I agree with others in that this should all be included in one fee or at least be covered without causing an additional deductible on behalf of the patient. However, in my case, I am changing health insurance companies after the first of the year, so I'm not sure how that would get resolved when one company gets the deductible and the other doesn't. Our whole health system is just a broken, horrible mess!

Griping aside, I thank God every day that I am still able to get insurance. I have had breast cancer twice in less than 3 years and was just finishing my first year of treatment when there were rumblings that the ACA would be repealed. I was terrified that I would no longer be able to get insurance. As bad as it is currently, I cannot even begin to imagine how I would have paid my medical bills without insurance.

Good luck to all of you!