Some information that you may want to know ...
In the last issue of the SC NURSE, I shared with you my personal celebration of Breast Cancer Month. As a follow up to that article, I asked the owners of a company here in Columbia to share some very helpful information that you may need/want to know for the future. They very generously responded with this article:
What You Might Need to Know about Post-Mastectomy Care Sherry Norris, CMF Co-Owner, Alala Boutique
When signing up for health insurance, your private health insurance company is required to let you know that they comply with The Women's Health and Cancer Reform Act of 1998 (WHCRA) if your mastectomy is covered by them. Here are some key points of the WCHRA, plus general reimbursement guidelines for Medicare and Medicaid:
* "Under WHCRA, if your group health plan covers mastectomies, the plan must provide certain reconstructive surgery and other post-mastectomy benefits."(1)
* "Under WHCRA, group health plans, insurance companies and health maintenance organizations (HMOs) offering mastectomy coverage also must provide coverage for certain services relating to the mastectomy in a manner determined in consultation with your attending physician and you. This required coverage includes all stages of reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produces symmetrical appearance, prostheses and treatment of physical complications of the mastectomy, including lymphedema?" (1)
* "I have not been diagnosed with cancer. However due to other medical reasons I must undergo a mastectomy. Does WHCRA apply to me? Yes, if your group health plan covers mastectomies and you are receiving benefits in connection with a mastectomy. Despite its name, nothing in the law limits WHCRA rights to cancer patients." (1)
Please remember, although the WHCRA does not govern Medicare or Medicaid, these insurances have some of the most generous coverage post-mastectomy. Medicare mastectomy recipients are eligible for 2 post surgery mastectomy camisoles, 6 mastectomy bras and one breast prosthetic per side. The camisoles are a onetime reimbursement based on surgery, bras are replicable every 12 months and the breast prosthetic every 24 months. These levels of reimbursement are a relatively new development.
Medicaid takes its lead from Medicare except they use the date of service to determine eligibility. So a Medicaid client is eligible for up to 4 post surgical camisoles be surgery, 6 mastectomy bras 12 months from their last date of service and one breast prosthetic per side every 24 months from the latest date of service.
As the front line of information to our patients we wanted you to be armed with the positive information that is available to you. As a small business we are challenged everyday in getting out the information that is needed to assist in the recovery processes. From the post surgical mastectomy patient wondering what to do with those dreaded and miserable drain bulbs, to the 15 year survivor who has never learned from any source that assistance is available and that she can give her husband back his socks that she has been using in her bra, we are here to help all who need it. It is indeed the little things in life that often make life so much more enjoyable. So learn more for yourself and for your patients and your family and friends!
1 United States Department of Labor brochure, "Your Rights After a Mastectomy ... Women's Health & Cancer Rights Act of 1998" Updated: October 2009
For further information:
WHCRA is administered by the U.S. Departments of Labor and Health and Human Services
Department of Labor
If you have questions regarding your AHCRA rights under an employer-sponsored group health plan, call the Department of Labor's Employee Benefit Security Administration toll free at 1.866.444.EBSA (3272) or visit the EBSA web site and click on Contact Us for the addresses of the 15 field offices that can assist you. You also can request a copy of Your Health Plan and HIPPA ... Making the Law Work for You and a list of all publications from the Employee Benefits Security Administration.
Centers for Medicare and Medicaid Services (CMS)
Go to the Web site for more information on WHCRA and HIPPA or call toll free at 1.877.267/2323
National Association of Insurance Commissioners
Visit the Web site and click on the State and Jurisdictions Map, then the state of your choice for the office in your state.
In South Carolina-Alala, LLC 803-545=4373
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|Title Annotation:||News You Can Use|
|Publication:||South Carolina Nurse|
|Date:||Jan 1, 2011|
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