Will Insurance Cover Bilat Mast if You Have Clear Margins??

Raili · January 2010

Hi everyone,

Once again, a question I know I need to talk with my doctors and insurance company with, and I'm in the process of that.... but I'm wondering about others' experiences...

If a woman has already had a lumpectomy with clear margins, would an insurance company use that as reason to say that a bilat mast is not "necessary" and thus not cover it? I have a re-excision scheduled for tomorrow to clear the margins, but I'm considering whether or not I'd want to have a bilat mast instead of radiation/chemo/hormone therapy. I'm worried that getting clear margins tomorrow would prevent that.

What about having a high Oncotype score? Would THAT be enough of a reason, to an insurance company, to cover the cost of a bilat mast?

Binney4 · January 2010

Ralli, hi,

A bilateral mastectomy doesn't necessarily get you out of chemo, rads or hormone therapy. I've had a bilat and all three of those treatments. Rads because the margin ended up being too close to the chest wall, so they had to radiate that. Chemo and hormone therapy because both are considered systemic treatments, and removing both breasts doesn't affect the need to treat the whole system in order to reduce the risk of mets or recurrence.

That said, my insurance covered both anyway because my doctor thought it was a good idea (I did have lobular carcinoma, and it has a tendency to show up later in the other breast -- and in fact the final path report showed previously-undetected LCIS in the second breast, so both my onc and I were glad we'd been proactive.)

These things sure aren't simple, are they! Tongue out Aaaaagh! Hope you find peace in your decision.

Be well!
Binney

Beesie · January 2010

Raili,

You say that you are "considering whether or not I'd want to have a bilat mast instead of radiation/chemo/hormone therapy". I don't understand. Did you not read the responses to the thread you started several days ago, in which you asked whether you would be able to avoid radiation, chemo and hormone therapy if you had a bilateral? Many of us explained that a bilateral will not get you out of chemo (if chemo is needed) and it may or may not allow you to pass on radiation and/or hormone therapy. Please read those responses before you go ahead with a bilateral on the assumption that you will be able to avoid those treatments.

As for having a high Oncotype score, that would mean that you need chemo and if you need chemo, it won't make any difference if you have a bilateral or not - you'll need chemo whatever surgery you have. In fact, if you need chemo, there is actually less reason to have a mastectomy, because while chemo is given to address the risk of distant recurrence, it also works to help reduce the risk of local recurrence, making a lumpectomy lower risk.

Raili · February 2010

Thanks, Binney and Beesie, for your patience with me!!

I was having a bit of a meltdown when I posted...not thinking so clearly! That was because my surgeon had emailed me to say "If you want to seriously chat about mastectomy, it wouldn't make sense to do the re-excision tomorrow, so track me down today if you want to talk about it..." and I interpreted that wrong. I thought she meant that if I chose to go ahead with the re-excision, I'd be forfeiting the mastectomy option... I thought I had to decide "I definitely don't want a mastectomy" by the END OF THE DAY in order to go through with the re-excision in the morning, and I was late for work and had no TIME to think about that huge huge decision. That's the backstory to my post! Luckily, my surgeon calmed me down and assured me that even if we cleared margins at the re-excision, mastectomy would still be an option later on down the road, if I chose that.

So that at least gave me more time to think about things. And yes, it was wrong for me to post in such haste because you're right, Beesie, that you all had just explained to me that a bi-lat wouldn't affect my need for chemo and may or may NOT obviate the need for radiation. However, I've decided to refuse chemo whether or not it's recommended, and in my particular case, it's very likely that I would not need radiation following a bi-lat - my surgeon is confident that a bi-lat would more than clear the margins. I know there are no guarantees with ANYTHING when it comes to cancer...wow, have I been learning that the hard way... but my surgeon did say directly, "If you choose bilateral mastectomy, it would obviate the need for any radiation." So I'm going with that.

Hormone therapy, I don't know where that comes into play... I have my first meeting with the med onc next week...

Will Insurance Cover Bilat Mast if You Have Clear Margins??

Comments

Categories