How much does a mastectomy cost, you ask?
Below you’ll find amounts billed (in US Dollars) by various providers for services related to my surgery. These are before insurance coverage/payment*. My out-of-pocket cost was $3,500/year.
|~$3,000.00||BRACAnalysis genetic test (100% covered by insurance)|
|$700.00||BRACAnalysis Rearrangement Test (BART; 100% covered by insurance)|
|$2,000.00||MyRisk genetic test (non-BRCA genes; 100% covered by insurance)|
|Mastectomy (nipple-sparing; tissue expander reconstruction), 01/2013|
|$448.59||Office visit, lab work, antibiotics/pain meds|
|Hyperbaric oxygen therapy (14 two-hour treatments)|
|$1,001.00||Consult with 1st doc, xray, EKG|
|$242.00||Consult with 2nd doc|
|$4,746.00||Attending doc fees for treatments|
|Post-op (expansions and other PS follow-ups were included in the PBM surgery costs)|
|$3,239.00||Expander ultrasound, seroma lab work|
|$104.00||6 month follow up with breast surgeon|
|Exchange surgery, 09/2013|
|$421.43||Office visit, lab work, antibiotics/pain meds|
|$20,010.00||Plastic surgeon (including implants)|
|Deconstruction surgery (infection on left side), 10/2013|
|Reconstruction surgery (expander placement; implant swap), 04/2014|
|$355.54||Office visit, lab work, antibiotics/pain meds|
|Exchange surgery, 09/2014|
|$638.00||Office visit, lab work, antibiotics/pain meds|
|$17,135.00||Plastic surgeon (including implants)|
|Deconstruction surgery (stitch abscess on right side), 10/2014|
|Reconstruction surgery (expander placement), 01/2015|
|Exchange surgery, 07/2015|
|~$300.00||Office visit, lab work, antibiotics/pain meds|
|Revision surgery (one implant bottomed out), 03/2016|
*PS: Insurance companies, levels of coverage, facility rates, and doctor/surgeon rates very and are billed differently. What I present here is my specific scenario, which may be very different from others’. If you are dealing with an insurance company, here are three very important things to remember:
- Call to get pre-authorization for everything. It is not terribly uncommon for an insurance provider to deny coverage or penalize the member if proper pre-authorization was not granted.
- Confirm your health provider is in-network. Any time you see a new provider, do this. Don’t assume that a physician is a network provider just because they work at the same hospital as the surgery. Each provider bills separately for their services and may not have a contract with the insurance company.
- Check when your plan year begins. Deductibles and out-of-pocket maximums reset when the plan year does (and this is not always concurrent with the calendar year), so if you have multiple procedures that span more than one plan year, you will have to pay those amounts twice.
PPS: That being said, by the Women’s Health and Cancer Rights Act (1998), insurance companies covering the mastectomy are required to provide coverage for all stages of reconstruction and treatment of physical complications. Note: this is if the insurance company covers the mastectomy.
Source: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.
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