surgery and insurance questions

Karidh

I'm not sure where to post this question. I hope this is okay.

I was diagnosed with DCIS based on stereotactic biopsy on Nov 14. The MRI strongly suggested an invasive component. I've seen my BS once who suggested I see the MO and PS before we scheduled anything, which made sense to me. I have seen the MO, been tested for BRCA, found out I am negative, but because of the size of the area on mammogram, and the MRI findings, he is recommending mastectomy with sentinel LN removal. Again that made sense to me. I had a consult with the PS, and have confirmed that I do not want reconstruction, but I would prefer BMX to feel symmetrical and to avoid worry. I have let the BS know all of this. At this point they are waiting for authorization from insurance, which I was told can take up to three weeks, so don't worry if I don't hear from them for a while. I guess, I just feel like this is moving so slowly. Is this all normal? and now I am worried that I am going to be told that insurance will only pay for unilateral mastectomy. Does anyone know if it is likely? I want a final diagnosis. I want to start getting rid of this badness that is inside of me...

coraleliz

Insurance is hard to figure out. I really don't think they will deny you a bilateral mastectomy. Why is it taking 3 weeks to authorize? Not sure, maybe the holidays?

Ariom

I am not in the US, but some time ago there was another woman on these boards asking this same question because she had been denied the prophy. I did some searching and found some information for her, which stated that in the US, you could not be denied a BMX, that you could request a prophy on the other side, for symmetry. I am fairly sure it was a government decision.

I can't recall where I found this information, but I remember the other woman managed to get what she wanted, by sticking to her guns and insisting it be investigated through the insurance company. I am sorry I don't have a better recollection, but it would be worth investigating further, if you run into problems with the BS.

Karidh

thank you, that helps.

Moderators

It really depends on your insurance, however, it probably is worth a call to your insurance company, as 3 weeks seems long. They should provide a toll free number, and after a bunch of number pushing, you should be able to get through to someone.

muska

I had a similar situation before BMX. Despite low clinical staging before surgery there were no problems with getting insurance approval, it took a couple of days to get approval. I am in MA, US.

pajim

Massachusetts state regulations require insurance to cover "matching" surgery, and reconstructive surgery.  That's why so easy to get approval in MA.  Other states may have different regulations.

Holidays do make a difference.  I know it's taking a long time, but this really isn't an emergency. 

Good luck!