Insurance Denied Bi-lateral Mastectomy

SusanSmay

Hey Ladies,

I was scheduled to have a bi-lateral mastectomy today, however, I was told Monday that BCBS of Oklahoma denied the bilateral mastectomy.  They did approve a unilateral mastectomy for the breast with cancer, but not the removal/reconstruction of the non-cancerous breast, even though there is a family history of breast cancer (maternal grandmother and mother), and I requested the prophylactic surgery because at the end of the day, when this is all over, a double mastectomy with or without reconstruction is what will  help me feel the most whole. 

My breast surgeon told me it was a federal law that they are to cover surgery of the non-cancerous breast, that in fact she could argue recurrence risks and high-risk statistics all day long and be denied, but if she told the insurance company that it was for purposes of symmetry, they had to approve it. I have contacted the Oklahoma Insurance Commission and received information that states the exact same thing, with more detail, but BCBS still denied the procedure.

My doctor is appealing the decision and has requested to talk to a breast specialist that works for the insurance company and we have decided to hold off my surgery for two weeks in hopes the appeal with be approved by then, but I am wondering if there is anything else I can do or anywhere else I can turn for help?  I was told I could submit an appeal as well, but I haven't officially received the letter stating that it was denied, so I am not certain if or how to proceed there.

Has anyone else faced this an won the appeal? 

Thanks, Susan