Insurance coverage for bilateral mastectomy

PeggySull

Has anyone had their insurance cover a prophylactic mastectomy when they didn't have BRAC1 positive results?



I want a bmx. I am 61 and in the middle of chemo and having an extremely difficult time with SE and can't imagine going through chemo again.



Plus, if I get a recurrence in two years, for example, I will be on Medicare and will not have the same choice of physicians I had this time.



If anyone did get a box without BRAC1 and got insurance coverage, how was it presented to the insurance company?



Any help in this regard would be much appreciated.

softness1

My insurance company did. Cigna. I think a law passed in the late 90's that requires that they must. Not sure the wording but look it up

Moderators

Hi Peggy,

There's also an Insurance and Other Financial Issues forum where you can ask your questions.

Hope this helps!

--The Mods

Linda-Ranching-in-the-mTns

I just had a BMX Nov 6 of this year -- with PRMA in San Antonio.

As far as we knew -- the left breast had cancer -- the right did not. I am 57 -- and when they did the lumpectomy, tiny 'surprise' tumors (previously undetected by MRI/sonogram/Mammogram/Ct-scan) were discovered in what should have been clean margins.

I seriously began to doubt that the machines can see as much as I thought they should. 

So -- I agonized over whether to have the right breast removed, too... and consulted two different breast reconstruction centers... (in Denver and San Antonio -- both do the DIEP reconstruction).

I was told both places that in the fairly near future, new insurance changes will probably no longer cover prophylactic removal.... but for now -- most insurance companies do.

What swayed me was the idea that by the time I finish my reconstruction -- a full year of my life will have been dedicated to breast cancer. There is no way I would choose to devote another year in the future to more surgery and more recovery. I want my life to be as full of LIFE as possible -- not illness.

With your past experience -- I can understand your concern and your desire. 

I assume that you already have a dx on one breast -- and perhaps have had a lumpectomy?

Are they suggesting a mastectomy for the one breast? If so, I am pretty sure you can add the second. 

If your docs think you are 'done' for now (with the lumpectomy/chemo/rads) then it might be a harder fight... but if mastectomy is already called for, I believe most insurance companies will allow the second removed as well.

I have BCBS.

Best of luck -- your docs can be your best advocates with the insurance company -- and will probably know the answer to this question.

Linda

Wren44

I think there's a legal requirement that you can achieve symmetry. If your ins would pay for reconstruction it should pay for mx.