Tumor removed in breast last year, now the doctors are saying the cancer is back and has spread to her lymph nodes under her arm.
Doctors says it should be removed as soon as possible.
Is anyone else out there in a similar situation? My aunt has insurance but what about the stuff insurance does not cover? Just more BS to stress her out more.
Mobile, AL.
does your information above apply to medicaid??
2nd...why would you pay for your friends illnesses like your posts says above?
That's why you cannot help your family member now, because you helped your friends medically - financially..
Your friends should have went through social programs 1st before asking their friends for donations on their medical bill.
Even Hospice Care.
It won't cover if she can't live by herself and needs Caregivers to come to her home.
Insurance will cover Home Health and Aspire, where a Nurse will come to the home, an Aide for bathing and a Nurse Practioner for Rx
What you can do is be there for her. You can help with all of the medical stuff, you can make meals, you can watch something funny with her.
Go when you can, whether it's once a day, once a week, or whatever works for your schedule. If other family has time, then enlist their help too.
Your help will be appreciated, more than you'll ever know.
I mean, the alternative would be no treatment at all because her insurance might not cover it. I'd take the treatment if it was up to me and worry about the expense later.
Straying a bit, I noticed she had the Humana medicare supplement. My mom switched to that a couple years back as it was a lot cheaper and on paper had the same coverage. But my mom fell, broke a pelvis, and while they covered rehab the choices of places you could go to were far less, obviously the crummier ones.
We switched her back to her other one this year. The guy said they have tons of people who switched to Humana then are switching back. I hear horror stories about Humana all over.
I dont know if that is an issue in this particular case, but it is in a lot of them.
"Medicare usually doesn't cover cosmetic surgery unless it's needed because of accidental injury or to improve the function of a malformed body part. Medicare covers breast prostheses for breast reconstruction if you had a mastectomy because of breast cancer."
The questions others asked is does your aunt have a supplemental or an advantage plan? If not, basic Medicare doesn't cover a whole lot (I have not used much of it, so I don't know the details.)
You can call Medicare (or the supplemental/advantage plan) and ask detailed questions about coverage, copays, deductibles, etc to know what to expect. Often doctors can get pre-approvals and know what to expect for coverage and financial obligations. Your best answer would come from the insurance reps. Draft the questions before calling, take notes and ask additional questions if the first answers bring up any.
If your aunt isn't comfortable tackling this, call anyway with her there and let her give permission to speak with them (for the most part the questions are general, but if outside insurance is involved, then they would have to review her policy, which would require her permission for you to speak with them.)
AlvaDeer says:
"As my own doctor said when I explanted (had removed) the fake boob that was nothing but problems for 30 years, "Flat is all the thing now". And it appears to be."
HAH! While not exactly "flat", I might as well be! It took me years to finally realize bras did NOTHING for me, so I don't bother with them. Seems like every time I get a mammo done, they "see" something and put me through hell a second time (or more). I have had, long ago, 2 small benign lumps removed, no cancer. Last time was the "great" 3d - sure enough, come on down to repeat... for nothing, except I get billed because they don't cover diagnostics, only the mammo. Of course they don't tell you that until you've done it and been billed! I told them most likely they pull this again I will not come back. IF it showed up as cancer, just take the damn tissue - boobs don't define me!
I also had a doc try her damnedest to talk me into implants. How many ways can one say NO before they listen? Again, boobs don't define me. I finally told her that 1) they served their purpose, 2) they're out of my way and 3) when I get older they won't be down HERE (referring to mid-stomach.) Some time after that we start hearing about all the issues, sometimes because of the contents, leakages, etc. Nope. I'm all set!
Given your aunt's age, does getting reconstruction make sense? I wouldn't put myself through a second surgery, esp when trying to recover from the cancer surgery and possible chemo afterwards. They do make breast prostheses. These would be less invasive, likely less expensive***, but make her clothed appearance seem normal. I doubt she's running to the nude beach...
*** CALL insurance to confirm, but I found this too:
"Most insurance companies will cover costs for the prosthesis and mastectomy bras, and Medicare will cover them as medically necessary. Patients should get a prescription from their doctor stating their diagnosis and the need for a right or left breast prosthesis and prosthetic bras."
If she tries the prosthesis and doesn't like it, she can always reconsider the reconstruction surgery.
She may be depressed, and may not feel too positive about life. You might want to consider how you can help her with these post-surgical aspects if they occur.
Just thinking ahead: the issue of lymph nodes post surgery was addressed in a free seminar I attended. The presenter specifically addressed that issue in terms of cancer surgery since lymph nodes are often removed. I don't remember everything she said, but lymphedema can develop (my aunt had it) and can cause very severe fluid retention problems.
You might want to research this and ask the surgeon when she/he gives the post surgical update (just after your aunt would be brought from surgery to the recovery room) - I'm assuming you would be there for the surgery?
I wouldn't address the issue with her; but be prepared to help her with intervention and finding medical treatment if fluid retention occurs.
My sister never had any problems with this though. But she was a runner and in top physical condition, other than for the cancer.
What I would do though is to specifically ask the surgery boarders at each of the doctors' offices for suggestions and assistance. The plastic surgery doctor especially should have a surgery boarder and/or employee who handles billing and would be more knowledgeable about funding.
Another source might be Gilda's Club. If you're not familiar with it, it was created on behalf of Gilda Radner, and focuses on cancer in many stages. Your aunt may find support there, before and after her surgery.
TF cancer support hotline: 888-793-9355 .
202-659-9709 for more information on support clubs, and ask for the Affiliate Relations Department: or e-mail to:
info@cancersupportcommunity.org
Your aunt is also very lucky to have a niece who's so involved and desirous of helping her through this challenging time.
Don't stress!
You can contact your local cancer society, they are always willing to help.
Contact your office on aging if she is low income. They will help you out and or direct you to the right people.
Good luck!
After ALL OF THAT, if Aunt still requires care and chemo and such ongoing them do know that insurance pays what insurance pays. The remainder of the bills are open for "negotiation" and can be negotiated down for someone without funds. Aunt may not have strength to do this, which is why the POA is so helpful. Also know that Aunts funds and assets stand for her bills. These medical bills will be (in our country) necessary for your Aunt to live. If she dies deeply in debt so be it; as they always say "You cannot get blood out of a turnip".
As a nurse I will tell you that I saw much heartbreak in our country and much of that around medical bankruptcy. They happened more to the INSURED than the uninsured, because the insured were ineligible usually for medicaid and such. So here would be these patients thinking that they had good insurance. They had copays of perhaps 10%. Figure when the bills starts honing in on 500,000 and what 10% actually represents then. So bankruptcy in the end when Aunt is all well and treated can end up to be the only option.
I wish you Aunt love and luck and healing. My own breast cancer 33 years ago was positive in two nodes, yet I am still here. And 78 without any recurrance of the cancer. I hope that will give her hope.
There are programs for people who are in need--I didn't need help, but it was good to know that it was available for those who needed it.
I was at a teaching hospital, and they don't turn ANYBODY away. Had I been at the 'Big Hospital' my care would not have been better, by any means. If I could not have afforded the care, I imagine they would have shuttled me to the teaching hospital.
The last thing you need when battling cancer is money worries. Do what you can for your aunt--but most of all. Don't forget her and leave her fending for herself.
Does she have a Medicare supplement?
Www.bogleheads.org is a great place to ask financial as well as insurance questions.
My aunt has Humana Insurance but she is in network for removal only here in Mobile, Al. She has to have a total mastectomy performed - my aunt is telling me there are 2 surgeons. 1- for removal and 1 for plastic surgery. The removal surgeon will take the Humana insurance it covers for the removal part. The cosmetic portion is another story there is no surgeon in Mobile that will take her insurance and is out of network here for the cosmetic portion. I guess my best bet may be to look at another surgeon in another area.
If your relative has no money, she needs to apply for Medicaid. Have you looked into that?
Best of luck; sending a hug and a prayer for her full recovery.