Insurance bilateral mastectomy question

I have anthem bcbs and had a BMX.  I only had cancer in one breast but elected to have both removed.  I did not have a tram or diep, I chose to go the implant route.  My insurance covered everything 100%.  No questions, no problems. 

Good luck!!

That has been a question on my mind as well.  We have a PPO insurance but when I said something to my "navigator" about possibly doing a BMX since the left breast has hyperplasia cells as well, and her first response well you'd have to check with your insurance first.  I was taken aback by that comment.  I don't know if she was just trying to  get me to reconsider and go for the lumpectomy instead of a MX on the right on the cancer side or what.  I have not felt very comfortable with her since which is sad because she is supposed to be the one helping me through all this tangled web.

I didn't mean to hijack your thread but the comment from one of the pp said there is no reason to deny a BMX even if only 1 breast is diseased got me wondering again.

Good luck in your decision and getting insurance to pay.

Dawn 

Let's go to the source.  Here is the link to Anthem's coverage guideline for contralateral prophylactic mastectomy.  You should have no problem getting your mastectomy covered in the non-diseased breast because of your history if you change to Anthem.

http://www.anthem.com/medicalguidelines/va/f5/s10/t2/pw_a036255.pdf

 Hope this helps...best wishes.

Gail

I know this is an old thread but I am going through this as well. I want to do this bilateral because even though I don't have the BRCA gene, there is adequate history to show that it is likely to reoccur. Out of 5 aunts and cousins who had breast cancer (father's side), the there was one at age 40 with it in both sides, and two who chose radiation who had recurrence.. and two more who had lateral mastectomies (1 side) and no recurrance On top of that I am triple negative! It was found very early, very small, but it is fast growing/high mitosis. Invasive was first missed but recently retested by a second pathologist and invasive was found. I have BCBS PPO (the highest,most expensive government plan... so not medicare, not HMO, not high deductible (although I will surely meet my out of pocket maximum this year)). The doctors have said I am very high risk (maybe not quite BRCA, but definitely a genetic thing going on). They have previously recommended that another cousin get bilateral mx just as preventative. There is also LOTS of other cancer in the family line including related cancers like prostate, colon, uterine.

I am one day from the surgery and I find out they won't pay for the second side... really? Is radiation/chemo, mammograms, follow up MRI's every 6 months etc... really that much less expensive?

I am venting now. Tomorrow I will get to work making phone calls trying to figure out what needs to be done.

Hello,

I had UMX on the left breast covered by United Healthcare, in 11/16. My insurance will change to BCBS in 09/01/17, I'm planning to have a lift on the right breast and removing the TE from my left At the same time. My question is would the breast lift be covered by insurance, even though I may do recon later? Thanks for your inputs.