Prophylactic Mastectomy & Aetna?

F2C

Long story short, my risk score is 29.5%... I do not have a gene however, my Mother, her sister, their Mother, and even their Father all had breast cancer...early age onset (30s for the females, 40s for my Grandfather).

My Breast Specialist' nurse said she's seen Aetna deny patients who they'd thought would be a slam dunk for approval of Prophylactic double mastectomy.

I'm about to be 30 and am tired of going every 6 months. I've also recently had a biopsy that showed Fibromatoid changes with Fibrocystic changes and Usual Ductal hyperplasia (I have 2 neoplasms but she just biopsied the 1).

I'm worried to death that our insurance will deny my surgery because it's on my chart that my Mother had BRCA mutation however, since her passing and me getting ahold of her records, I can't find any evidence of her actually being tested...so I'm not sure if my Dr includes that in the letter they send insurance, if it'll help or hurt my cause? It doesn't change my risk score. We've also only had this insurance 6 months due to Covid so I'm afraid that's another reason they'd deny. Has anyone else been approved by Aetna strictly on family history and their own risk score?

MelissaDallas

Here is Aetna’s policy on prophylactic mastectomy:

http://www.aetna.com/cpb/medical/data/200_299/0227.html

MelissaDallas

Also, it isn’t necessary to keep posting the same question on multiple threads/forum

SoulShine1969

F2C-

I'm sorry for the passing of your mother. Having so many family members with early onset breast cancer must be very scary. You mention that your risk is 29.5%- is that based on genetic testing? Were your other family members tested? I tested positive to the BRCA1 mutation and had a bilateral prophylactic mastectomy and reconstruction several years ago, and a few revisions as well. I also have Aetna and they have never denied any surveillance or surgery I have needed regarding BRCA.

Best of luck to you.

F2C

SoulShine, my risk score was calculated by my specialist using some kind of TC thing that I can't spell for the life of me. I tested negative in 2015.

Also, I apologize about posting in more than 1 category. I wasn't sure I was posting to the correct ones 🙈

MelissaDallas

FTC, no worries about the multiple posting. It is just that the same handful of people tend to monitor the active topics to respond to newbies, so one place is seen by all of us. If you ended up with multiple active threads, it is hard for you and everyone here to keep up with and update