Ask the Doctor: Do You Take Medicare Replacement Plans for Breast Reconstruction?

This week, Gail Lanter, CPC Practice Manager, of The Center for Natural Breast Reconstruction answers your question.

Question: The worst part of my battle was with a Medicare Advantage Plan HMO. I’ve switched to a different plan and am thrilled with the way my breast cancer situation has turned out. We are not objects for the medical community. Most women would never initiate what I have had to go through. I am so thankful that I have gone the route I did.

Answer:  Thanks for reaching out. Sounds like things are going well for you, that’s great to hear!

We understand completely the problems many patients are having with Medicare Advantage (Replacement) plans, both the PPO and HMO’s. They are difficult and sometimes impossible to deal with from both the patient and provider perspective. We have decided that our practice will not accept new patients with a Medicare Replacement plan going forward for microsurgical free flap breast reconstruction procedures – only Traditional Medicare.

Maybe one day we’ll reconsider – but not until some significant improvement in both the provider service and claims processing areas within those payers takes place. It’s awful the way two of the top 10 largest insurers in the United States who offer Medicare Replacement Plans treat patients and their providers and it should be stopped.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!

Ask The Doctor-Does Medicare Cover the Cost of Surgery?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I had breast surgery in 2014- one breast removed but the Dr. left enough flesh to reconstruct. I hate surgery and afraid of the length first of all. Second, I have heard there are SEVERAL operations and most of all does Medicare cover the cost. I pay for the best you can get and I am 66 yr old. Thanks.

Answer: Thanks for your question. You are correct that breast reconstruction does require more than one surgery. Depending on several factors such as what technique is used the surgery can also take a long time. Using your own tissue to remake a natural permanent new breast is what we specialize in but we also use implants if our patients choose that option.

Medicare does cover breast reconstruction but no matter how much you are willing to pay for the expertise Medicare will only pay the surgeons a set, very low fee. Fortunately that’s ok because we are physicians and our mission is to provide the best for all our patients. At this time we do accept Medicare and will as long as we can continue to fulfill our mission. Please let us know if you have any other specific questions.

Have a question about breast reconstruction or post-surgical you’d like answered from our surgical team? Just ask!”