Breast Reconstruction and No Insurance

I know that breast reconstruction after a mastectomy is no longer considered cosmetic by insurance companies, but I wonder, if the hospital or the state is picking up the bill, will they also include the reconstruction if the patient wants it? Maybe someone out there with experience in hospital administration or possibly a doctor who has done this kind of work might be able to clue me in.

I don’t have an answer for you, but if insurance pays for a prosthetic reconstruction for men who’ve had a testicle removed due to cancer and not for reconstruction after removal of a breast due to cancer, they’re opening themselves up to all sorts of discrimination suits.


Will work for sig line.

The insurance companies have no worries about discrimination suits. Their policy is to pay for all testicular reconstruction, regardless of the patient’s gender.

SDCOMN!

(That’s an abbreviation for “Spewing Diet Coke Out My Nose”. Meaning that last line caught me off guard and made me laugh so hard I spewed Diet Coke out of my nose. Except that I don’t actually drink Diet Coke. In fact, I don’t drink Diet anything. Or Coke anything. So I definitely wouldn’t drink something that was both Diet and Coke at the same time. But I digress.)

Little Nemo…you crack me up.

Girlface,

Just start phoning the hospitals and talking to the billing departments - they will know who pays for what and the phone numbers to call.

You could even call reconstructive surgeons’ offices, somebody there does billing and knows all this info practically by heart.

It should vary according to location (state laws?) so you should talk to someone near you or the prospective patient.

GirlFace:

What a peculiar way to start a debate.

I wonder if you’d mind revealing a bit more of what’s prompting the question. If it’s to gather information that can be utilized on behalf of you or an acquaintance who may have need of it, you might be better served in General Questions.

OTOH, there are a lot of REALLY smart people who hang out here in GD, and even if your question is more practical than … confrontational, will do I suppose, you’re likely to find just what you’re looking for from them.

But if you really are just looking for arguments to break out, well, what are you driving at?


Of course truth is stranger than fiction. Fiction has to make sense.
Mark Twain

The answer, of course, is it depends…

The circumstances, I would think, would be quite different between the state paying (Medicaid/Medical DOES pay something, even if it’s typically 20-40 cents on the dollar for care provided to beneficiaries), and the hospital sucking up the cost…

If a treatment is considered “standard of care” by a majority of insurers, in general, Medicare WILL pick up the tab, subject to state-to-state variations & a whole host of specific inclusions & exclusions unique to each circumstance. Oregon, for example has taken a hard-line approach, and Medicaid there covers only the most common 500 conditions. Your baby is born 12 weeks premature, and has a 5% chance of growing to be normal, 15% chance of some degree of permanant disabilty & 80% chance of dying despite costing the state hundreds of thousands of dollars. Sorry, you lose. No intensive care is provided. (numbers are off-the top of my head for illustration purposes only)

Hospitals OTOH, generally provide only that care which is medically urgent before releasing a patient to whatever they can accomplish with their own means. Breast reconstruction would generally NOT fit this requirement. Adjuvant chemo-, radiation, or hormonal therapy probably would. (It’s cynical, but I believe that the acid test is whether a patient can successfully sue for omission of a given treatment)


Sue from El Paso

Experience is what you get when you didn’t get what you wanted.