My mom has precancer and she is going to have a mastectomy done. she is in the process of getting medicaid(hopefully it goes through) but for now she has some type of insurance called Promesa Salud and i wanted to kno if promesa salud or medicaid will cover for reconstructive surgery after her mastectomy
Yes
…but this can be tricky. It is a much more complicated question than you might realize. Medicaid is run by individual states, so the rules can change from state to state. Medicare is run by the Federal government and is a bit more streamline.
Contrary to what many people believe, post-mastectomy breast reconstruction is NOT considered purely cosmetic and is therefore covered by most insurance plans and Medicaid plans. That should be easy…but not so fast.
Chances are your mother will have the mastectomy by a general surgeon, or perhaps a breast specialist who accept Medicaid as payment. Finding a surgeon to take off a breast with Medicaid/Medicare is pretty easy. Finding a surgeon that accepts Medicaid to reconstruct a breast is not as easy.
There simply aren’t many plastic surgeons who accept Medicaid, it is just the nature of their business. Furthermore, contrary to what many people think, it is quite rare that both operations take place at the same time (even though it would be a little more efficient if that were the case), so often you are dealing with added expense for a second operation.
If it is important to your mother, you really need to do a good job researching this. Make sure that your surgeons understand what your goals are and try to figure out what your options are based on where you live. Ideally you would have a breast surgeon who routinely works with plastic surgeon (perhaps a single group of docs) who both operate at the same place. This way both surgeons are involved from the start and can come-up with a good plan long before your mom has the surgery.
Good luck.
No, Because it’s considered cosmetic. The will only cover if it is medically necessary. I know it seems it may be, but in there minds women don’t need breast. It’s not life threatening. Best of luck!
References :
EmporiaWest
Yes
…but this can be tricky. It is a much more complicated question than you might realize. Medicaid is run by individual states, so the rules can change from state to state. Medicare is run by the Federal government and is a bit more streamline.
Contrary to what many people believe, post-mastectomy breast reconstruction is NOT considered purely cosmetic and is therefore covered by most insurance plans and Medicaid plans. That should be easy…but not so fast.
Chances are your mother will have the mastectomy by a general surgeon, or perhaps a breast specialist who accept Medicaid as payment. Finding a surgeon to take off a breast with Medicaid/Medicare is pretty easy. Finding a surgeon that accepts Medicaid to reconstruct a breast is not as easy.
There simply aren’t many plastic surgeons who accept Medicaid, it is just the nature of their business. Furthermore, contrary to what many people think, it is quite rare that both operations take place at the same time (even though it would be a little more efficient if that were the case), so often you are dealing with added expense for a second operation.
If it is important to your mother, you really need to do a good job researching this. Make sure that your surgeons understand what your goals are and try to figure out what your options are based on where you live. Ideally you would have a breast surgeon who routinely works with plastic surgeon (perhaps a single group of docs) who both operate at the same place. This way both surgeons are involved from the start and can come-up with a good plan long before your mom has the surgery.
Good luck.
References :