by Ramona du Houx
Before Lee Lyford of Waterville underwent breast cancer surgery last year, her insurance company told her a 24-hour or more post-operative stay in the hospital was not medically necessary and refused to authorize a longer stay.
At Lyford’s insistence and after the procedure, her insurance agreed to cover her full hospital stay following the double mastectomy, but her experience reminded her of stories about other women who were sent home less than 24 hours after surgeries because their insurance companies were reluctant to cover longer stays.
At a public hearing at the State House Thursday, Lyford thanked Rep. Thomas Longstaff, D-Waterville, for sponsoring a measure to prevent others from being sent home prematurely by ensuring breast cancer patients and their doctors, rather than insurance companies, determine the length of their hospital stays.
Longstaff’s bill, LD 359, would help breast cancer patients by requiring insurance policies to cover hospital stays of at least 48 hours for patients undergoing a mastectomy or lumpectomy. Currently, he said, breast cancer patients’ stays are sometimes cut short because of what insurance companies decide to cover.
“Particularly for such an important and invasive procedure as a mastectomy, the length of hospital stay should be determined by the patient and her doctor,” said Longstaff. “Unfortunately, even when both agree that a longer hospital stay is medically appropriate, some patients’ stays are shortened because the insurance provider is reluctant to cover an overnight stay.”
The bill would also require health insurance policies to cover no less than a 24-hour stay following a lymph node dissection, another procedure to treat breast cancer.
Longstaff’s bill would add Maine to the at least 21 states that currently address the problem of so called “drive-through mastectomies” with laws requiring a minimum period of inpatient coverage following a mastectomy.
“The 48 hours after surgery are when complications such as bleeding and infection are most likely to occur. The decision as to whether a patient needs to stay in the hospital is best made by the physician based on his or her professional judgement and in response to the individual patient’s condition,” said Lyford testified before the Insurance and Financial Services Committee. “It is not a decision that should be made ahead of time by an insurance representative.”
Hilary Schneider, director of governmental relations in Maine for the American Cancer Society’s Cancer Action Network, also testified in support of the bill.
“A decision about when a patient is ready to leave the hospital after cancer surgery is one that is best left to a doctor and the patient,” said Schneider.
Local lawmakers Reps. Catherine Nadeau, D-Winslow, and Henry Beck, D-Waterville, are cosponsors of the measure.
“No breast cancer patient should be forced to return home prematurely simply because her insurance provider won’t cover her as an inpatient,” said Nadeau, who is a surgical technician by training and has extensive experience in health care. “Health care professionals and their patients, not insurance companies, should make these decisions.”
According to the Maine Center for Disease Control, breast cancer is the second leading cause of cancer-related death among U.S. women.
The Insurance and Financial Services Committee will hold a work session on the measure in the coming weeks before making a recommendation to the full Legislature.
Longstaff is serving his third term in the Maine House. He is a member of the Veterans and Legal Affairs Committee and represents part of Waterville.