Prophylactic (Mastectomy #2) and Insurance

Options
NMB
NMB Member Posts: 3
edited June 2014 in High Risk for Breast Cancer

Hi all, I am new here but have been lurking for a couple of weeks.  Right breast mastectomy in August... 8 rounds of chemo (2nd round tomorrow) then rads. 

Met with genetic counselor Friday (BRCA test sent to Myriad) and have decided on prophylactic mastectomy on left breast and OOPH regardless of BRCA outcome due to family history.  Feel very confident with this decision (here and Susan Komen board reinforce this.) 

I have one nagging question (at the moment...)   Anthem covers prophylactic BUT are they going to have an issue with me not having it done with my original mastectomy???  Oh, and I assume they will automatically cover rescontruction for BOTH breasts?  My reconstruct is not till spring (expander)

· Share on FacebookShare on Twitter

Comments

  • tweekerbeeker
    tweekerbeeker Member Posts: 93
    edited October 2009

    not sure about the first issue, but if they pay for the mast., they MUST pay for recon., even if it is later.

    · Share on FacebookShare on Twitter
  • Sue-61
    Sue-61 Member Posts: 599
    edited October 2009

    My best advice is to call your insuror and get yourself a case manager. She/he can walk you through the whole process and assist with the prior approval. And let you know if it is covered. (I think it usually is..........) Sue

    · Share on FacebookShare on Twitter
  • spar2
    spar2 Member Posts: 6,827
    edited October 2009

    I was told one year my insurance didn't cover the tatto of the nipple and then Our insurance changed.  Are they suppose to cover the tatto of a nipple?  Anyone know?  Thanks much.

    · Share on FacebookShare on Twitter
  • Texas357
    Texas357 Member Posts: 1,552
    edited October 2009

    My insurance covered my prophylactic about 9 months after my bc mastectomy. My ps told me that every part of the reconstruction is covered.

    · Share on FacebookShare on Twitter
  • Anonymous
    Anonymous Member Posts: 1,376
    edited October 2009

    Glad you asked this question.  I've been contemplating this myself.  Already had mastectomy and free tram reconstruction.  Now the thought of going for mammagrams on the other breast is really scaring me.

    · Share on FacebookShare on Twitter
  • NMB
    NMB Member Posts: 3
    edited October 2009

    Thanks all!  Had a LONG day at the hospital today (major port issues) but am calling Anthem tomorrow.  Will post what they say.

    · Share on FacebookShare on Twitter
  • CAROLMARIE427
    CAROLMARIE427 Member Posts: 206
    edited October 2009

    I had a prophylactic 10 months after my original mastectomy and my insurance company (GHI) paid for that and the reconstruction in full.  I was BRCA negative but I fit the criteria for a strong family history and a personal history of breast cancer.

    · Share on FacebookShare on Twitter
  • Annabella58
    Annabella58 Member Posts: 2,466
    edited October 2009

    glad to find this thread! 2 years out from original mtxmny, no nodes, BRAC -, but I am going for it anyway.  They want me to lift and reduce which makes NO sense as I could still get cancer in the remaining hoot.  I have anthem, I'll be very interested on their take on this.  I hope it gets covered for you!  Does anyone know if there is a time limit on when the coverage for the remaining recon of other gal gets done?

    · Share on FacebookShare on Twitter
  • sueper13
    sueper13 Member Posts: 1,224
    edited October 2009

    Nancy et. al.

    Womens Health and Cancer Rights Act of 1998;

    http://www.dol.gov/ebsa/publications/whcra.html

    You have lots of rights from this.  Anyone close to Dallas, I have found the correct doctors who got a prophylactic mast and bilat DIEP flap recon fully covered except for about $3,000 for the hospital. PM me for more info if you'd like.

    Sue

    · Share on FacebookShare on Twitter
  • NMB
    NMB Member Posts: 3
    edited October 2009

    I talked to my nurse case manager and she feels it should be covered but did go over the appeal process just in case.  Alwasy be sure the surgeon requesting the PA be very clear for the reasons (and multiple reasons, just in case)

    Surgeons office states they have never seen it denied and have  the fun opportunity to see surgeon again on Thursday since I need a port revision (darn) so will talk to her again.  Could not get through to normal customer service so will try again tomorrow. 

    Here is the link for Anthem coverage  ttp://www.anthem.com/medicalpolicies/policies/mp_pw_a053359.htm

    · Share on FacebookShare on Twitter

Categories