Surgery tomorrow

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sweetvickid
sweetvickid Member Posts: 459 Member
edited March 2014 in Breast Cancer #1
Tomorrow I will have a double mastecomy and of course the insurance refuses to pay for the unaffected breast Did anyone else have to pay for the mastecomy for an unaffected breast. I was wondering about the cost. Surgeon's office could only tell me what his cost would be.

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  • greyhoundluvr
    greyhoundluvr Member Posts: 402
    #2
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    Sweetvickid
    I am sorry to hear that you are having to deal with this on top of everything else. I did not have to pay for mine - my insurance covered the surgery for both the affected and unaffected side. It could be difficult to get an estimate for the hospital side of the surgery because they should only be passing on costs that would not have been incurred if it were not for the prohylactic part of the surgery (for example additional OR/anesthesia time, supplies). Services that are going to be required because of the "main" surgery should be covered. If you run into problems breaking this out, most hospitals have an audit staff that might be able to sit down with you and help break out these charges.

    You may have already been through this, but you may also want to appeal the denial of the surgery on the prohylactic side. If you do, I would suggest getting any letters you can from your surgeon and oncologist that support the reasonableness of doing the surgery. You may also want to gather health carrier position statements on prophylactic mastectomy from some of the major carriers in your state (many of them are available on-line). If you can show that your carrier has a more aggressive position than the norm, you may have some success pushing it up the ladder. I wish you the best of luck!

    Chris
  • Christine Louise
    Christine Louise Member Posts: 426 Member
    #3
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    Fight this
    I had a bi-lateral mastectomy, with one side unaffected. Insurance paid. Lo and behold, when the removed tissue was tested, the supposedly healthy breast had worse cancer in it than the other! It hadn't shown up on mammogram or MRI! Thank goodness we were able to make the lucky decision.

    I hope you fight your insurance on this. I don't know how you appeal, but insurance itself can probably tell you the procedure, and maybe the surgeon's office knows how. Maybe talk to a lawyer? Best of luck to you!! Let us know what happens, please.
  • New Flower
    New Flower Member Posts: 4,294
    #4
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    Christine Louise said:

    Fight this
    I had a bi-lateral mastectomy, with one side unaffected. Insurance paid. Lo and behold, when the removed tissue was tested, the supposedly healthy breast had worse cancer in it than the other! It hadn't shown up on mammogram or MRI! Thank goodness we were able to make the lucky decision.

    I hope you fight your insurance on this. I don't know how you appeal, but insurance itself can probably tell you the procedure, and maybe the surgeon's office knows how. Maybe talk to a lawyer? Best of luck to you!! Let us know what happens, please.

    Good luck with your surgery
    when you recover and feel ok try to appeal insurance decision. It is not going to be easy, but possible to fight. Ask your oncologist and surgeon for a letter of medical necessity. Right now please focus on your health.
    Hugs

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