Is Your State Preventing Drive-through Mastectomies?

In the 1990’s, many insurance plans began limiting inpatient care following a mastectomy orbilateral mastectomy in an effort to contain costs. They reduced insurance coverage for in-hospital stays to 24 hours following these major surgeries, and classified these procedures as outpatient. Prior to this, a woman’s physician usually determined how much in-hospital care she would need before returning home. Categorization of these extensive surgeries as outpatient procedures earned them the title of Drive-through Mastectomies.

A woman being prepared for surgery

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What’s wrong with the idea that a woman can return home after she demonstrates she has recovered fully from the anesthetic if she has someone to take her home? It is dangerous! It may be cost-saving initially but not so in the long run.

What could go wrong? There is the danger of infection and bleeding and being groggy and nauseated from anesthesia.There is usually the need to administer powerful medications intravenously for pain relief. If a woman has reconstruction immediately following having her breast(s) removed, this will add several more hours to her surgery.

A woman needs time to learn how to care for the surgical drains that will carry fluids away from her wound site(s) for several days following her surgery. She also needs a few days to adjust to what has just happened to her, not just physically, but emotionally. Every woman needs the opportunity to stay in the hospital for a minimum of 2 days, and longer if there are complications.

I did not have reconstruction for my second primary breast cancer; I went into surgery at 8:30 AM for a bi-lateral mastectomy, and woke in recovery at 3 PM. Nauseated, on a morphine drip, unable to get up and use the rest room, I cannot imagine how difficult it would have been for me to go home just hours after surgery. After 2 days recovery time, I was able to go home confident that I knew how to take care of myself.

 I remember all too well my experience following my outpatient lumpectomy 10 years earlier. I arrived for surgery at 7:30 AM. I was taken to the operating room going on 1PM. The standard at that time was a 1 step procedure that began with a biopsy of what was removed from my breast while I was still under anesthesia. Then, based on the findings, my surgeon would either do a lumpectomy or a mastectomy. I awoke in the recovery room after 4PM to learn, for the first time, that I had breast cancer, and my surgeon had performed a lumpectomy.

The procedure had taken longer than anticipated and I was groggy and severely nauseated from being heavily sedated. By 8PM, I was still too out of it to walk by myself. So I asked if I could stay overnight and leave in the morning. I was told that wouldn’t be possible without written authorization from my insurance carrier, and it was too late to arrange that given the time.

It was bitter cold out, and snowing heavily. My son had to carry me to his car and then into my apartment, once he got me home. There needs to be exceptions to the 24-hour limit for special circumstances, even for lumpectomies.

Through the advocacy efforts of breast cancer support groups and elected officials, over 20 states have passed legislation that requires health insurance companies to cover a minimum of a 2-day hospital stay and longer for more complicated surgeries.

 Unfortunately, “Drive-through Mastectomies” are still prevalent in over half the states in the U.S.

Elected officials are working on legislation to put a stop to what has become a national trend. The House of Representatives has approved legislation that would end the practice of "drive-through" mastectomies.

"The Breast Cancer Patient Protection Act" (H.R. 135), would make it mandatory for insurance plans to provide at least 48 hours of inpatient hospital care after mastectomy surgery. There also would also be a minimum of 24 hours inpatient care mandated after a lymph node dissection.

This legislation allows for shorter inpatient stays if a woman and her physician feel it is right for her. Insurance companies will have to pay for stays longer than 48 hours if the physician feels it is necessary.

To learn whether your state has a policy in support of “The Breast Cancer Patient Protection Act" see Mastectomy Hospital Stays.

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