Breast Cancer Patients: Reconstruction is the Law, But.... Good Luck

In 1998, a federal law was passed requiring insurance companies, including government subsidized insurance, to cover the plastic surgery necessary for women who wanted their breasts reconstructed after their breasts were removed to treat breast cancer.

Ten years later -- most women aren't getting that surgery, at least in Michigan and New York State. Many want it! But they can't get it. After the horrors of a cancer diagnosis, the difficult and debilitating surgeries to remove their breast, breasts or portions of their breasts -- they can't get that final surgery that will help them feel less invaded and more "normal."

Why? Because very few plastic surgeons will do the reconstruction surgery -- because they don't get paid what they want to get paid for it. They can't make enough money, so they don't do the surgery. This, according to Jim Mulder's article in today's Post Standard.

I hear it now -- your outrage! BUT -- in this case, it's not just the plastic surgeons we need to be angry at. It's the insurance problems that lead to the unwillingness of these surgeons. Wait till you hear these numbers:

Doctors are business people. They need to keep their offices open and their lights on. They need to make enough money to cover their costs, to pay off their hundreds of thousands of dollars in student loans, and to make a good living for themselves. OK -- granted -- they want to make a lot of money. We can't blame them.

Breast reconstruction surgery takes anywhere from 5 to 11 hours, depending on how much cancerous tissue is removed, therefore how much reconstruction needs to take place.

The national average cost for reconstruction for one breast is $9,300. In New York State, Medicaid reimburses $600. Six hundred dollars! What a joke!

So, the plastic surgeon has a choice -- s/he can do a 5 to 11 hour surgery on one patient and be paid in cash at full price, tens of thousands of dollars. Or s/he can do a Medicaid breast reconstruction for $600.

If you had the choice, which would you choose?

Even private insurance doesn't reimburse enough to make a plastic surgeon pay attention. Some plastic surgeons are now asking patients to pay cash for the surgery, then get their insurance to reimburse them, the patients later. That means that in the midst of this horrifying diagnosis, a woman needs a way to come up with as much as $20,000 -- and hope to get part of it back later from the insurance company she has been paying into for, sometimes, dozens of years.

What's wrong with this picture? Will breast cancer reconstruction surgery become one more way to divide the "haves" from the "have nots?" Obviously -- yes it will. It already does. And it won't improve until either the reimbursements improve, or until we have a national healthcare system of some sort.

That's another question for another day.

Have you had breast cancer surgery, and (in effect) been denied reconstruction surgery due to payments and reimbursements? Why not share your story in our Patient Empowerment Forum?
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