Breast Reconstruction Funding

Tori · New User Joined: 07 Jun 2008 Posts: 8

In 20 days I will have my 3 year mastectomy anniversary.

In one way, it's a good anniversary because I'm still alive.

In another way, it TOTALLY sucks because I didn't have insurance, and therefore wasn't able to have reconstruction surgery.

I'm still making payments on the 2 surgeries I had in 2005 so money is an issue; but LET'S FACE IT.... who the heck would have $25K sitting in the bank to pay for the surgery I need even if my financial status wasn't so dire???

My cancer was my wake-up-call to finally divorce my "spouse" (sorry, but the word "husband" doesn't apply because he's totally screwed me over for money & I've been in the middle of a nasty divorce for just under 3 years) - another good thing, the getting rid of him part....

My point there is that besides the cash-flow problems that come with cancer, the divorce is another major factor. I'm glad to be rid of him, but I sure miss my money - not that it was much... lol... Confused

Everywhere I call tells me that since I'm under 65 and don't have kids that I can't get any help.....

In this land of plenty called America, I found only one organization that helps with reconstruction, and it's called My Hope Chest. They have a website & I applied for help, and am on the waiting list.

It's a GREAT foundation & God bless the founder for starting it. She had the same problem years ago, but thank goodness she was able to have her surgery after she went back to work & regained health insurance benefits.

Unfortunately, the organization needs lots of help itself to enable it to fund surgeries, and for whatever reason.... people just aren't aware of the tremendous need. I spoke with the founder & she told me there are THOUSANDS of women in the same boat.

Does anyone have any ideas they can share with me???

My faith is EXCELLENT because God is good AND THEN SOME... but it sure would be nice to hear something positive... like that someone on here knows Oprah & will get the word to her to help My Hope Chest and/or instruct her accountant to set aside a fund for reconstruction.... Or at least feature them on a show during her Breast Cancer Awareness week of shows in October.....

Anyway...... that's my story, and I've put it out there in hopes of SOMEONE SOMEWHERE having some ideas to help me & the thousands of other gals out there in need of a boob or 2........

Thanks for being on this board! We all need to help each other out because cancer is one evil bugger that needs to be defeated!!!

Barbara K · Regular Joined: 11 Apr 2007 Posts: 33

You have two options.

If you already have medical insurance, it doesn't matter how long after the original mastectomy, the insurance company is required by law to pay for the reconstruction surgery.
More specific and detailed information about this law and variations by different states is available at this link.
http://messageboards.makemeheal.com/viewtopic.php?t=72904&sid=8916961efa06c78a81867c3c34482d51

If you do not have medical insurance, then Option 2 is for you to apply for the Free Medical Assistance Program for Breast & Cervical Cancer.
The same requirement applies here, once you have this Medical Assistance coverage, by law, they must pay for the reconstructive surgery regardless of how long it’s been since you’ve had your mastectomy. This is NOT considered to be a purely cosmetic procedure. Instead, it’s considered to be a medically necessary procedure after a mastectomy.

Here is a general link that explains the Medical Assistance Program for Breast & Cervical Cancer.
http://www.coverageforall.org/pdf/FHCE_FedPovertyLevel.pdf

If you respond to my email and let me know which state you reside in, I can get you detailed and specific information of the eligibility requirements and application process for that state. After working for 29 & 1/2 years for Public Welfare, I know how to search through government websites for information and applications.

Barbara K.

Barbara K · Regular Joined: 11 Apr 2007 Posts: 33

I posted the wrong link in my previous message.
That link was the link to the Federal Poverty Income limits charts.

The correct link where it describes the Breast & Cervical Cancer Prevention & Treatment Act of 2000 is here.

http://www.cdc.gov/cancer/nbccedp/legislation/law106-354.htm

My apologies for putting the wrong link in the previous message.

Barbara K.

Tori · New User Joined: 07 Jun 2008 Posts: 8

Hi Barbara,

THANKS SO MUCH for your reply & the information!!!

OMG, U JUST MADE MY DAY!!!

I like to think that I'm somewhat informed; but people don't tell u the truth sometimes when u look for help... for whatever reason....

I live in Florida.

I just said to my BF on the phone earlier today that the Office Manager where I worked for about 6 months in 2006, who administered the health plan told me I couldn't get surgery thru the plan, and that I would make the rates go up & the owner wouldn't be too happy about that. I lost my job a few months later, and I've had occasion to wonder if my health concerns were why..... I was told that my job was being "phased out", but I know that was a lie because they hired more people after I left.

And I told my friend I was thinking of contacting an attorney now that I'm well past the trauma that came with a mastectomy in 6/05, initiating a divorce in 11/05, and then getting fired in 6/06....

Helluva year, ya know???

Your message today was definitely sent down thru the cosmos because I've been thinking on this lately, and just today verbalized it.....

Whatever info you've got, I'd love to know.

Again, THANK YOU!!!!!!!!!!!!!!!

Barbara K · Regular Joined: 11 Apr 2007 Posts: 33

Tori;

For Florida, the best place for you to start is at the following link.
http://www.doh.state.fl.us/Family/bcc/default.html

The white paper report about this program is available in pdf format using this link.
www.floridasac.org/documents/report_bccc.doc

Another good link is here at this url
http://www.ahirc.org/cat_list.cfm?cat=198&st=FL

The eligibility requirements in Florida for uninsured women is age 50 to 65 and the income limit is 200% of the Federal Poverty Income Guideline.
http://ahca.myflorida.com/Medicaid/medicaid_reform/pdf/medicaid_eligibility_guidelines_083104.pdf

Barbara K.

Barbara K · Regular Joined: 11 Apr 2007 Posts: 33

Hi Tori:

It's Barbara again.

I reread the documents again and realized I gave you incorrect information.

The eligibility for the free screenings at the first link
http://www.doh.state.fl.us/Family/bcc/default.html
puts an age limit of women aged 50 to 65.

The eligibility for the Medicaid program as listed in the pdf document states that this program is available for women under age 65 (any age, as long as it's less than 65) and 200 % of the Federal Poverty Income Guidelines.

http://ahca.myflorida.com/Medicaid/medicaid_reform/pdf/medicaid_eligibility_guidelines_083104.pdf

My apologies for the error in my previous message.

Barbara K.

Tori · New User Joined: 07 Jun 2008 Posts: 8

Hi Barbara,

Thanks again! I'm checking all the links to see what applies to me & looked at the links you'd posted previously.

I am 43 & had my mastectomy at age 40 when I was uninsured.

Would you know if I should have been covered thru my work health plan that I mentioned in my earlier post?

Like I said, I thought about it this past week or so & then just mentioned it to my friend about the whole intimidation factor at my job so I didn't pursue it further 'cause I'd hoped to stay employed.

Thank you so much.

Barbara K · Regular Joined: 11 Apr 2007 Posts: 33

You should have been covered under your work insurance while you were still employed there.
However, once you lost the job, then you also lost that coverage. There's no legal way you can force your previous insurance to pay for breast reconstruction surgery now.

Barbara K.

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