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Tumor removed in breast last year, now the doctors are saying the cancer is back and has spread to her lymph nodes under her arm.


Doctors says it should be removed as soon as possible.


Is anyone else out there in a similar situation? My aunt has insurance but what about the stuff insurance does not cover? Just more BS to stress her out more.


Mobile, AL.

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IF she needs surgery, she should get it.  Whatever the insurance does not cover, she can set up a payment plan with the hospital,etc to pay off the bill.  They can't deny a payment plan and should be willing to work with her in getting that done.  Wishing her luck and you.
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Reply to wolflover451
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Spend down Aunt's funds to Medicaid eligibility. Her relatives should not pay her bills.
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Reply to Patathome01
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cetude Sep 1, 2020
Better see an eldercare attorney. If you don't spend-down correctly it can turn into a penalty.
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Imho, perhaps you aunt can apply for Medicaid.
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Reply to Llamalover47
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No doubt about it it has to be removed as soon as possible, especially in lymph nodes that spreads like fire.

does your information above apply to medicaid??

2nd...why would you pay for your friends illnesses like your posts says above?
That's why you cannot help your family member now, because you helped your friends medically - financially..
Your friends should have went through social programs 1st before asking their friends for donations on their medical bill.
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Reply to Manson
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Iraters. Basically covers all medical.
Even Hospice Care.

It won't cover if she can't live by herself and needs Caregivers to come to her home.

Insurance will cover Home Health and Aspire, where a Nurse will come to the home, an Aide for bathing and a Nurse Practioner for Rx
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Reply to bevthegreat
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Talk to a social worker or community service advisor in your neighborhood. Is she eligible for Medicaid? There may be other programs or services that can help her.
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Reply to NYCdaughter
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Talk with the doctor, the office manager, the hospital social worker about your aunt's finances. They know of resources in your area and can help put a plan into place so your aunt can get the care she needs.
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Reply to Taarna
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I think the American Cancer Society and/or the Susan G. Komen Breast Cancer Foundation might offer help in terms of rides to appointments and possibly financial help. I think some hospitals also have financial assistance. If she needs follow-up mammograms, some hospitals offer them at a reduced rate. Some of this might depend upon her area, but the above mentioned organizations might be a place to start. She also might be eligible for Meals on Wheels, to save some money. Also, you might want to contact her Area on Aging. They might have some further suggestions. Also, if she belongs to a house of worship, they might be able to help in terms of financial assistance and/or volunteers to help in a variety of ways. Also, I believe there's a website called "Medgift," where you can ask for things that you might need when you're sick. Hope some of this helps. Best of luck.
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Reply to rlynn123
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If she can get on Medicaid, then do that. but don't stress about the cost of care. If she cannot pay the bills, they cannot get money from a turnip. And her medical bills dissolve once she dies -- as long as one does not co-sign the medical bill responsibility.
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Reply to cetude
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You can only do what you can do, and the money is finite. Having said that, what you can do to alleviate her stress is exactly what you are doing, which is to help. People who are sick, in whatever way, need help. They are tired, it's hard to do daily chores and it's time consuming to follow up on doctors, appointments, medication and so forth.
What you can do is be there for her. You can help with all of the medical stuff, you can make meals, you can watch something funny with her.
Go when you can, whether it's once a day, once a week, or whatever works for your schedule. If other family has time, then enlist their help too.
Your help will be appreciated, more than you'll ever know.
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Reply to Rabanette
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The bills, whatever accumulates, will be her responsibility. Does she have insurance PLUS Medicare? If so, there may be very little out of pocket. At any rate, she will receive care with the insurance she has, so balance owed can be settled with the providers at a later date. And, yes, they will settle for much less than you owe - often half or even less than that. And if she's too worrisome about the bill, pay $10 a month for the rest of her life.

I mean, the alternative would be no treatment at all because her insurance might not cover it. I'd take the treatment if it was up to me and worry about the expense later.
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Reply to my2cents
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jacobsonbob Aug 31, 2020
As far as I'm aware, no hospital has ever chased a former patient down to re-insert a cancerous tumor or an inflamed appendix!
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Many good answers and I hope her and her Aunt the best . As said, she had no legal obligation per se but its admirable she wants to help an aunt who helped her anyway. (that said, I know caregivers have to take care of themselves too)

Straying a bit, I noticed she had the Humana medicare supplement. My mom switched to that a couple years back as it was a lot cheaper and on paper had the same coverage. But my mom fell, broke a pelvis, and while they covered rehab the choices of places you could go to were far less, obviously the crummier ones.

We switched her back to her other one this year. The guy said they have tons of people who switched to Humana then are switching back. I hear horror stories about Humana all over.

I dont know if that is an issue in this particular case, but it is in a lot of them.
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Reply to Karsten
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Simple search showed this:

"Medicare usually doesn't cover cosmetic surgery unless it's needed because of accidental injury or to improve the function of a malformed body part. Medicare covers breast prostheses for breast reconstruction if you had a mastectomy because of breast cancer."

The questions others asked is does your aunt have a supplemental or an advantage plan? If not, basic Medicare doesn't cover a whole lot (I have not used much of it, so I don't know the details.)

You can call Medicare (or the supplemental/advantage plan) and ask detailed questions about coverage, copays, deductibles, etc to know what to expect. Often doctors can get pre-approvals and know what to expect for coverage and financial obligations. Your best answer would come from the insurance reps. Draft the questions before calling, take notes and ask additional questions if the first answers bring up any.

If your aunt isn't comfortable tackling this, call anyway with her there and let her give permission to speak with them (for the most part the questions are general, but if outside insurance is involved, then they would have to review her policy, which would require her permission for you to speak with them.)

AlvaDeer says:
"As my own doctor said when I explanted (had removed) the fake boob that was nothing but problems for 30 years, "Flat is all the thing now". And it appears to be."

HAH! While not exactly "flat", I might as well be! It took me years to finally realize bras did NOTHING for me, so I don't bother with them. Seems like every time I get a mammo done, they "see" something and put me through hell a second time (or more). I have had, long ago, 2 small benign lumps removed, no cancer. Last time was the "great" 3d - sure enough, come on down to repeat... for nothing, except I get billed because they don't cover diagnostics, only the mammo. Of course they don't tell you that until you've done it and been billed! I told them most likely they pull this again I will not come back. IF it showed up as cancer, just take the damn tissue - boobs don't define me!

I also had a doc try her damnedest to talk me into implants. How many ways can one say NO before they listen? Again, boobs don't define me. I finally told her that 1) they served their purpose, 2) they're out of my way and 3) when I get older they won't be down HERE (referring to mid-stomach.) Some time after that we start hearing about all the issues, sometimes because of the contents, leakages, etc. Nope. I'm all set!

Given your aunt's age, does getting reconstruction make sense? I wouldn't put myself through a second surgery, esp when trying to recover from the cancer surgery and possible chemo afterwards. They do make breast prostheses. These would be less invasive, likely less expensive***, but make her clothed appearance seem normal. I doubt she's running to the nude beach...

*** CALL insurance to confirm, but I found this too:
"Most insurance companies will cover costs for the prosthesis and mastectomy bras, and Medicare will cover them as medically necessary. Patients should get a prescription from their doctor stating their diagnosis and the need for a right or left breast prosthesis and prosthetic bras."

If she tries the prosthesis and doesn't like it, she can always reconsider the reconstruction surgery.
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Reply to disgustedtoo
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Hospice will advise
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Reply to DKelso34
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Tpaul69 Aug 29, 2020
Right
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Another aspect to consider is post-cancer recovery.   Does your aunt live alone?   Does she have any close friends, relatives or neighbors who can help her?   

She may be depressed, and may not feel too positive about life.   You might want to consider how you can help her with these post-surgical aspects if they occur. 

Just thinking ahead:   the issue of lymph nodes post surgery was addressed in a free seminar I attended.   The presenter specifically addressed that issue in terms of cancer surgery since lymph nodes are often removed.   I don't remember everything she said, but lymphedema can develop (my aunt had it) and can cause very severe fluid retention problems.  

You might want to research this and ask the surgeon when she/he gives the post surgical update (just after your aunt would be brought from surgery to the recovery room) - I'm assuming you would be there for the surgery?

I wouldn't address the issue with her; but be prepared to help her with intervention and finding medical treatment if fluid retention occurs.  

My sister never had any problems with this though.   But she was a runner and in top physical condition, other than for the cancer.
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Reply to GardenArtist
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I don't know if you could get a Medigap Plan now, but it's what we have to cover for the portion that Medicare doesn't pay.  I will state honestly though that I don't know how much of the plastic (or reconstructive) surgery would be covered, or if your aunt could get it now that she has knowledge of the need for that surgery.

What I would do though is to specifically ask the surgery boarders at each of the doctors' offices for suggestions and assistance.   The plastic surgery doctor especially should have a surgery boarder and/or employee who handles billing and would be more knowledgeable about funding.

Another source might be Gilda's Club.  If you're not familiar with it,  it was created on behalf of Gilda Radner, and focuses on cancer in many stages.   Your aunt may find support there, before and after her surgery.

TF cancer support hotline:  888-793-9355 .
202-659-9709 for more information on support clubs, and ask for the Affiliate Relations Department:  or e-mail to:

info@cancersupportcommunity.org

Your aunt is also very lucky to have a niece who's so involved and desirous of helping her through this challenging time.
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Reply to GardenArtist
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AlvaDeer Aug 28, 2020
As my own doctor said when I explanted (had removed) the fake boob that was nothing but problems for 30 years, "Flat is all the thing now". And it appears to be. An individual decision for certain, but I would never do it again. Everyone is different. As to the lymph nodes, my doc took I think 15 out of I don't even know how many we have under the arm. I was positive in two of the nodes, but here I am three decades later; too mean to go, I guess. Great strides being made daily in treatment in our times. I sure wish the aunt good luck.
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You have no obligation to pay medical debt!

Don't stress!
You can contact your local cancer society, they are always willing to help.
Contact your office on aging if she is low income. They will help you out and or direct you to the right people.

Good luck!
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Reply to OneWhiteFeather
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First of all, I hope that perhaps Aunt, if you are willing, will make you her POA for future, when and if she cannot handle things temporarily or permanently as you are her good advocate. Secondly, while Aunt is hospitalized ask for a Social Worker at once. Ask for help making application with your Aunt for help in payments for her care. Hospitals by law must also provide some services to those who have no funds to pay. Check out everything you can access, including medicaid.
After ALL OF THAT, if Aunt still requires care and chemo and such ongoing them do know that insurance pays what insurance pays. The remainder of the bills are open for "negotiation" and can be negotiated down for someone without funds. Aunt may not have strength to do this, which is why the POA is so helpful. Also know that Aunts funds and assets stand for her bills. These medical bills will be (in our country) necessary for your Aunt to live. If she dies deeply in debt so be it; as they always say "You cannot get blood out of a turnip".
As a nurse I will tell you that I saw much heartbreak in our country and much of that around medical bankruptcy. They happened more to the INSURED than the uninsured, because the insured were ineligible usually for medicaid and such. So here would be these patients thinking that they had good insurance. They had copays of perhaps 10%. Figure when the bills starts honing in on 500,000 and what 10% actually represents then. So bankruptcy in the end when Aunt is all well and treated can end up to be the only option.
I wish you Aunt love and luck and healing. My own breast cancer 33 years ago was positive in two nodes, yet I am still here. And 78 without any recurrance of the cancer. I hope that will give her hope.
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Reply to AlvaDeer
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Isthisrealyreal Aug 27, 2020
But only until you meet your deductibles are you paying the 10% or 20% which is much more common especially on Medicare or medicare Advantage plans. Just so u know.
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When dxed with cancer last year, the hospital checked and re-checked with me to make sure I would have funds for my treatment.

There are programs for people who are in need--I didn't need help, but it was good to know that it was available for those who needed it.

I was at a teaching hospital, and they don't turn ANYBODY away. Had I been at the 'Big Hospital' my care would not have been better, by any means. If I could not have afforded the care, I imagine they would have shuttled me to the teaching hospital.

The last thing you need when battling cancer is money worries. Do what you can for your aunt--but most of all. Don't forget her and leave her fending for herself.
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Reply to Midkid58
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Tpaul69 Aug 27, 2020
Thanks so much
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Is she on Medicare? Does she have a Medicare Advantage policy or straight Medicare (which generally pays 80%)?

Does she have a Medicare supplement?

Www.bogleheads.org is a great place to ask financial as well as insurance questions.
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Reply to BarbBrooklyn
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Tpaul69 Aug 27, 2020
Barb,
My aunt has Humana Insurance but she is in network for removal only here in Mobile, Al. She has to have a total mastectomy performed - my aunt is telling me there are 2 surgeons. 1- for removal and 1 for plastic surgery. The removal surgeon will take the Humana insurance it covers for the removal part. The cosmetic portion is another story there is no surgeon in Mobile that will take her insurance and is out of network here for the cosmetic portion. I guess my best bet may be to look at another surgeon in another area.
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Sometimes the clinic billing/insurance department can estimate what is covered and what is not. It's worth asking, or a call to Medicare to see what to expect. I wish her all the best and peace in her heart. You are awesome for being there for her!
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Tpaul69 Aug 27, 2020
Thanks G. I will be sure to check on this asap.
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Are you in the US?

If your relative has no money, she needs to apply for Medicaid. Have you looked into that?
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Reply to BarbBrooklyn
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Tpaul69 Aug 27, 2020
Yes, In Mobile, Alabama - Thank you.
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She doesn't have private insurance or Medicare to pay for health care costs? If not, she'd need to apply for Medicaid to cover her during her cancer treatments.

Best of luck; sending a hug and a prayer for her full recovery.
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Reply to lealonnie1
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Tpaul69 Aug 27, 2020
Thanks :) yes, she has Insurance but ???? I guess I need to check out all the details about what all is not covered.
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Medicaid. Why do you feel obligated? She needs to apply for Medicaid on her own with the help of her local APS to give her direction. She should not be refused treatment. If you hand her money for treatment, you can possibly mess up her application acceptance.

Offer her sympathy and if you can help her with transportation when she gets treated instead
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Reply to MACinCT
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Tpaul69 Aug 27, 2020
Mac, I don't feel obligated. I'm just trying to help out my aunt who has been there for me and took the place of my mom in raising me. I appreciate the directions and any advice given. Yep, and u can bet I will be taking her for her tumor removal next week or should i say lymph node removal. Hell IDK, I'm just really upset about all of this as we are really close. Auntie has insurance but the parts the ins. won't cover. Just more bs to stress her out more.
Thanks
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