(Info You May Not Find Elsewhere)
Get a
case manager
One
of the first calls you need to make to you healthcare network is to request to
be assigned a case manager. The case manager can be your best friend
in the
insurance field by smoothing the way for pre-certifying
medications and procedures and helping with the complexities of billing. You
will call the case manager directly rather than having to go through the
standard phone menu and having to explain your situation to a new person
again.
Why is my wig not covered by insurance
Your employer contracts with the insurance company for health benefits.
They select a benefit package suitable for their employees and their
families and within a budget. Your employer elects to include,
or not include a wig in the benefit package based on many factors. Since wig
benefits are a contractual issue, there is basically nothing that can be done to
get your wig paid for by the insurance company if a wig is not included.
Do you have a Flex dollars of some kind?
Go to your employer's human resource manager and negotiate with them to
pay all or part of the wig, because "you need a good wig to be presentable
and self confident at work, and it will help you psychologically in the
healing process."
Are my
Breast Forms (Prostheses) and Bras Covered
By Insurance and Medicare? YES THEY ARE!!
See "The Woman's Health And Cancer Rights Act of 1998" below. In summary,
Federal Law mandates that any insurance company that pays for the removal of
a breast due to cancer must also reconstruct that breast and or pay for
mastectomy products. Almost every insurance policy will pay for 1 breast prosthesis (2 if
bilateral) every other year and 2 to 4 pocketed mastectomy bras every year.
Of course, there are exceptions so check with your insurance company.
Some providers of mastectomy products will charge you full price for the
products and then bill your insurance company or Medicare as a courtesy. Call around and
find a boutique that 'takes assignments.' This means that you do not have to
pay up front, instead you pay only your co-pay and the bill the insurance
company and the insurance company pays the boutique. If you cannot find a place that
takes insurance assignments, then try The
Susan G. Komen Foundation, Easter Seals, or The American Cancer Society.
Approved Providers
Insurance Networks spend a lot of time and energy developing
their provider network which includes physicians, clinics, hospitals,
physical and occupational therapists, and durable medical equipment
providers. These 'Approved Providers' are required to take insurance
assignments. Many networks do not have an approved wig provider so you need to
know about the "30 mile rule," which states that if there is no approved
provider within 30 (in some cases 50) miles from your residence, the
insurance network must pay the provider you select as though they were
approved (in network) providers. It is necessary to call the healthcare network to find
if there is an approved provider and the limits of your benefits before
purchasing a wig.
Call American Cancer Society
Get information or brochures on
the many services they provide and contact the volunteers in your area.
"Reach to Recovery" will come to the hospital to help with guidance and
encouragement, and "Road To Recovery" volunteers provide transportation to
and from doctor appointments and chemo or radiation treatments.
"Look Good....Feel Better" is a 2 hour program designed to help the new
patients learn about wigs, scarf tying, skin care, and adjustments to their
skin care and make-up.
See more support groups at
http://www.cancer.org/docroot/SHR/SHR_2.asp.
The Women's Health and Cancer Rights Act of 1998
Wondering about breast reconstruction or paying breast
forms and bras?
Summary Information
Overview:
The Women's Health and Cancer Rights Act of
1998 requires insurers providing coverage for mastectomy surgery to provide
to the insured receiving benefits in connection with a mastectomy, coverage
for:
- Reconstruction of the breast on which
the mastectomy was performed
- Surgery and reconstruction of the other
breast to produce a symmetrical appearance
- Prostheses and physical complications
for all stages of mastectomy, including lymphedema, in a manner determined
in consultation with the attending physician and the patient.
Prohibits: (1) denying to a patient
eligibility, or continued eligibility to enroll or to renew coverage under
the terms of the plan, solely for the purpose of avoiding the requirements
of this section; and (2) penalizing or otherwise reducing or limiting the
reimbursement of an attending provider, or providing incentives (monetary or
otherwise) to an attending provider,to induce such provider to provide care
to an individual participant or beneficiary in a manner inconsistent with
this section.
Coverage under WHCRA
Whether WHCRA or a State law that affords you the same coverage as WHCRA
applies to your coverage will depend on your situation. Generally, WHCRA
applies if you are in a
self-insured plan. Your State law will determine whether WHCRA will
apply to coverage under an insured group plan, or to individual health
insurance coverage.
Contact your State's insurance department to find out about whether WHCRA
will apply to your coverage if you are NOT in a self-insured health plan.
Notice Requirements
The WHCRA requires group health plans and health insurance issuers,
including insurance companies and HMOs, to notify individuals regarding
coverage required under the law. Notification is required at three separate
times:
-
After enactment of WHCRA
-
Upon enrollment
-
Annually.
View the
Questions & Answers on the Annual Notice Requirements. The Q & A
document contains a Model Annual Notice, which will be particularly useful
to plans and issuers.
Statutory Text
The Women's Health and Cancer Rights Act (P.L. 105-277), enacted October
21, 1998, which amended the Public Health Service Act (PHS Act) and the
Employee Retirement Income Security Act of 1974 (ERISA). The law is
administered by the Department of Health and Human Services (DHHS) and the
Department of Labor. The WHCRA includes important new protections for
individuals who have had a mastectomy and who elect breast reconstruction in
connection with the mastectomy.
More Tips
(Stuff you need to know)
One
of the less talked-about side effects of chemotherapy for some women is
early menopause. Research suggests that the best predictors of who will have
this side effect are the age of the woman and the type of chemotherapy she
receives. The average age for natural menopause is 51, and the closer a
woman is to this age, the more likely she is to be thrown into menopause by
chemotherapy. A 45-year-old has about an 80 percent chance of going into
early menopause as a result, while a 35-year-old has about a 20 percent
chance.
The end of fertility?
Chemotherapy can bring on menopause by damaging a woman's ovaries and
reducing the amount of hormones they make. For women within a decade or so
of natural menopause, this change often is permanent, meaning the end of
menstruation and fertility. For younger women, though, it may be only
temporary. They may find that their periods return after the chemotherapy
ends, along with their ability to conceive a child.
If you start having symptoms of menopause while on chemotherapy, it's hard
to know which group you're in. Even if your periods become irregular or
stop, you still may be able to get pregnant. Since chemotherapy can cause
severe birth defects, especially in early pregnancy, it's crucial to use
birth control during treatment if you're sexually active.
Like natural menopause, chemical menopause can cause a wide range of
symptoms, including irregular or absent periods, hot flashes, trouble
sleeping, mood swings, fuzzy thinking, vaginal dryness, and loss of interest
in sex. In fact, the symptoms of this sudden menopause often are more severe
than the slow changes that occur naturally. Fortunately, there are several
options for treating any symptoms that are troublesome.
Aching Bones and
Joints
A drug named Nupregen is given to
chemo patients who have very low white blood count caused by chemotherapy.
Most patients report that Nupregen (Neurufibrosarcoma) causes aching of the
bones and joints for 3 to 5 days. One clientwas complaining about severe
aching in all her bones on a Saturday. I asked when she had a Nupregen shot,
and she wondered how I knew that she had gotten a shot. I replied that we
frequently hear about aching all over because of the shot.
Nupregen is given to "build up" your immune system after high doses of
chemo.
Procrit is given to help your body make more red blood cells, and in turn
gives you more energy.
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