No one knows the hidden costs of traveling for breast reconstruction surgery more than the patients themselves. I just returned from recent fat grafting as part of my own DIEP flap breast reconstruction. The costs are fresh in my mind and I feel it is an important topic to write about.
The WHCRA (Women’s Health and Cancer Rights Act of 1998) is outlined in this article. A portion of the article states:
“This federal law requires most group insurance plans that cover mastectomies to also cover breast reconstruction. It was signed into law on October 21, 1998. The United States Departments of Labor and Health and Human Services oversee this law.”
The devil is in the details. Look carefully at the wording, especially the word “most”. Insurance is becoming challenging for both patients and physicians. Costs, restrictions, increased deductibles and co-pays are driving up the costs for patients and many times decreasing the pay outs to physicians. Even if you find a qualified plastic surgeon to perform your breast reconstruction the deductible and co-pays alone can reach into the thousands of dollars.
Breast Reconstruction is seldom one surgery. There is normally going to be more than one surgical event whether you choose implant-based or autologous (using your own tissue) reconstruction. Many women work hard with their plastic surgeon to see if they can get procedures done in one year so that they can avoid starting those deductibles all over again in another year for subsequent and often needed surgery. It isn’t always easy to coordinate patient schedules along with the demands of the plastic surgeon’s schedule.
Beyond Insurance Costs
The hidden costs go way beyond insurance payout. I will outline the costs not covered by insurance. Travel and lodging are tax deductible medical expenses that can be claimed but are out of pocket for the patient. It is worth noting to keep your travel and lodging receipts for tax reporting purposes. I will go through non-covered insurance costs in a step by step list to give you an idea of what patients are faced with when the need to travel for breast reconstruction is part of their plan.
The Costs of Pre-Surgical Tests and Labs
Your plastics surgeon will require you to have a pre-surgical exam with your primary care doctor. This will include a minimum of a simple EKG and blood work. These are covered by insurance but again, there is the co-pay cost you will be responsible for. Patients are aware of hospital, anesthesia and subsequent lab costs from the surgery but these pre-surgical costs are also incurred and a must prior to surgery.
The Cost of Time off Work
This is lost revenue not only for the patient but for the traveling partner. My husband had to use vacation time to be with me for my surgeries. My sister, who came for one of my surgeries, is a nurse. Like my husband, she had to use her PTO (paid time off) to be with me.
The Cost of Parking
This is not a huge expense but everything adds up. There is not only airport parking to account for if you must leave your car at a paid lot while you are away but there is the costs of hospital garage parking for your caregiver while you are in hospital.
The Cost of Travel
Are you driving to your facility? Consider the fuel expense coming and going. Are you flying? Air travel is expensive. Not only do you have to buy a ticket to get to your plastic surgeon’s facility and hospital but so does your traveling partner. Once you get to the location of service you will need transportation. Car rental, Lyft, Uber, or taxi is yet another expense.
The Cost of Lodging
Hotel or vacation rental is another substantial cost. I get this question many times when women are preparing and planning their travel for breast reconstruction. Where did you stay when you had your reconstruction? They not only want something that is affordable but comfortable and finding that magic combination can be challenging. Many surgical facilities, my own included at PRMA, have lists of area hotels they partner with to reduce the costs to patients. I want to add that it is worth mentioning your plastic surgeon’s office to see if they have a contracted, reduced rate with area hotels. You can also mention the hospital you will be having your procedure at. The hospital rate for my most recent surgery was actually a lower price than what my plastic surgeon’s office contracted with for the hotel I stayed at. Mention both for the best price.
The Cost of Food
Eating out can run up a hefty bill. The other challenge is trying to eat as healthy as possible during your surgery. That is often a tough combination to work in your favor. Phase one of DIEP flap surgery requires that you stay in the area for a two week period. One week will be spent in hospital. The other week will be spent at a hotel or rental to recuperate and to see your plastic surgeon for a post op visit before you head home. I opted for a vacation rental for my phase one DIEP flap. It did allow me to reduce the cost of eating out and gave me control over eating healthy. I did grocery shopping a couple of days prior to my surgery and stocked the kitchen at the rental with healthy fruits, vegetables, soups, yogurt, Ensure (protein drink) and nuts. Don’t forget, it’s not just the expense of you eating. Your traveling partner has to eat, too. Yes, more hidden costs on the list.
The Cost of Prescription Medicine
You will be given medicine that will have to be taken after your surgery that might include pain medication, antibiotics, anti-nausea medicine and perhaps others depending on your current health history. There is also over the counter medicines that will be used such as stool softeners, as one example. Even though insurance will cover some of the costs of your prescription medication it won’t cover all of it. Put it on the expense list. It seems to be getting long, doesn’t it?
The Cost of Clothing
You will wake up with a surgical bra and compression garment after your surgery. These are provided for you by your hospital. Note: Not all plastic surgeons use compression garments (abdominal binders) after surgery. The added out-of-pocket cost to you will be the garments you wear after you are out of hospital. A t-shirt is added comfort to wear under your surgical bra. A button-front shirt or jacket will be worn for a couple of weeks after your surgery. This is to minimize use of your arms while you heal. Putting a garment on over your head can compromise the healing of the surgical site. A pair or two of loose fitting pull on pants will be needed for your trip home from the hospital as well as a few weeks after surgery until the swelling subsides. You may or may not have had these items in your closet and if you didn’t, it’s another expense.
The Cost of Undergarments
I’m putting this in a whole different category than clothing. Supportive underwear is so important after the surgical garments are no longer required when you are back home. You don’t have to break the bank getting fancy bras or abdominal garments but they do need to be supportive and you will want more than one of each. This is a topic that is frequently discussed on my Facebook forum. Which brand did you buy? How much was it? I can’t find one that is comfortable now. Shopping for these items is not always a fun event for post breast reconstruction patients when they are still in the healing phase not to mention, yet another expense.
The Cost of Scar Healing Creams
It is not recommended to buy ordinary over the counter lotions to help with scar healing. You need one that is recommended by your plastic surgeon’s office. It is not necessary to buy the most expensive. That doesn’t always translate into the best. However, these scar creams are typically more than the average lotions you would be using daily for moisturizing.
The Cost of Physical Therapy
My plastic surgeon wrote a prescription for ultra sound guided physical therapy for me after phase one of my DIEP flap surgery. It was of such value to my skin mobility and scar healing that I was more than happy it was part of his regime in post surgical healing. Again, it was covered by insurance but after my deductible was met and I was responsible for co-pays.
I purposely did not include the actual costs of any of these listed items because they can vary from patient to patient based on insurance and individual circumstances. My hope is that it will give patients a realistic look at the hidden costs of breast reconstruction. It is not meant to discourage. It is intended only as a mechanism for planning. My hope is that this list may also be a resource for plastic surgeons to use to inform their own patients of these costs if the patient may not be aware of these added expenses not covered by insurance.
There are support groups who can help with travel and they are listed on my resource page here under “Travel Assistance…” I know my own plastic surgery office also has resources available for travel assistance on their webpage. It is always worth asking your plastic surgeon if they know of any support to help curtail expenses.
Having breast cancer and deciding to make the choice to have breast reconstruction is such an important part of the healing process for so many patients. I am beyond fortunate to be surrounded by family who was willing to put forth the financial sacrifice to make this happen for me. My life has literally turned around since having my breasts removed from mastectomy in 2014 and having them beautifully rebuilt by a wonderful microsurgeon. I have no regrets. However, I felt it important to point out these hidden costs of breast reconstruction that aren’t always discussed and may be overlooked in the planning process. I know there may be others I have overlooked but I do hope this helps both patient and physician as part of the discussion in the breast reconstruction process.
Terri Coutee is the founder of http://diepcjourney.com/. Her blog provides resources along with a personal account of her own breast reconstruction. While working on her M.Ed. in Teacher Leadership, Terri was diagnosed for the second time with breast cancer. She turned her years of being an educator into a purposeful life becoming an advocate for breast reconstruction options after mastectomy. She has taken a keen interest in the passage of the Breast Cancer Patient Education Act. She actively participates in social media administering an on-line support group, sharing evidence based research and engaging in community activities that support breast cancer and breast reconstruction. You can find her on Twitter @6state or on Pinterest and Instagram @tgcoutee.