LCIS, Prophylatic Mastectomies & Insurance

Hi Shabby...I have United Healthcare (although plans probably differ) and mine was covered. As my BS said...."you are saving these guys a ton of money in the long run". My BS did all the paperwork. It was not a problem...but I do understand I had the same concerns.

Maryellen

Lizzy,

I did have my surgery it was on Feb 28. I chose not (at this time anyway) to have any reconstruction. I am back up and around, am drain free and getting used to my new "profile". I am scheduled to go back to work on Monday .

By the way my BS originally thought that PBMX was excessive,(but did say he would help me with whatever I decided) following his advice I did a ton of research, spoke to a PS and an ONC and in the end stayed with my original decision. When I went back to the BS he was nothing but supportive. He and his staff have been great!

Remember Lizzy, you are the boss...it is your life and your health! PBMX is an accepted treatment plan for LCIS and to your insurance company a heck of alot cheaper (and that is the bottom line with your ins company) than a lifetime of mammos and MRI's.

If this is what you want stick to your guns...also if your current BS will not help you as Mama used to say there are plenty of fish in the sea!

Good Luck!

Maryellen

also had united healthcare. pbmx and exchange surgery were fully covered (minus $200ish per each surgery)

Hi, I have Blue Cross as well and everything has been covered bmx and recon.



Lizzy, I struggled with this choice too and what might be considered an overly aggressive treatment. What is right for you is just that, and you have choices. I was so grateful for all of the technology, but it never fully erased my fear. I chose a single stage, nipple sparing surgery a year and a half after the diagnosis. It's only 4 weeks since the surgery, the relief that I have felt is surprising and it started when I woke up in recovery and they told me that the node biopsy was clear. I realized that deep down I had been fearful of something worse hiding in there. I'm worry free now and for me, it was the absolute right choice.



My 11 year old sons asked me if having surgery meant that I wouldn't ever have breast cancer. I explained that this would mean that I have done everything possible to eliminate that chance, even though nothing is ever a 100% slam dunk. They both very solemnly said "thank you, mom" and I was blown away. Those three little words were what really mattered.

I also have united healthcare and had no problems with their paying. Nan

Hi Lizzy, I did have reconstruction at the same time. I had a one step nipple sparing procedure and direct silicone implants under the muscle. I had a sentinal node biopsy as well.



Four weeks out, I feel dangerously good and kind of overdid it. My pain is minimal most of the time, but I get really tired around 3 most days and still can't lift much or reach certain ways. I did make it out to a fundraiser for a whopping two hours last night and that felt good and normal, except for the the fact that I was home and asleep by 7:30!

My friends mother was shocked that I came, and people that didn't know I had surgery told me that I looked great with no idea that I had any of this...that felt incredible!

BCBS covered my PBLM, thankfully. By law insurance companies must cover recon, but I declined that opportunity.



I declined the every three month breast assessment also. That aggressive monitoring is a world without end.



Preemptive aggressive treatment is a conservative way to get a near zero risk of bc.

Mammashells-I felt lifted by your posts.  I am in the process of doing my homework for a nipple/skin sparing PBMX followed by immediate recon.  I've been in the 6 month watch cycle for 5 years now and I am DONE! 

I am totally petrified by the thought of future bc, chemo, rads, and TISSUE EXPANDERS (don't ask me why).......I have 3 months to get this over and done with during the summer in 2013.  As a part time college instructor( I have part-time positons at 2 different colleges and I work both fall and spring semesters), I pay my own insurance and get no sick time.  If I leave my job, they fill my courses with another willing and able-bodied prof.

Other than that the next scary thing is the finances.  I have a huge out-of-pocket deductible in my plan, but they have open enrollment in December.  I am thinking about increasing my coverage and paying the higher premiums for a year or more.  It would be a lot cheaper than my current plan. 

Does anyone know if this is a possible route to choose?  What is the downside?

So glad I found this topic!  I was diagnosed with ILC on May 2009.  I had a lumpectomy and radiation.  I am in year 4 of the Tamoxifen.  The original biopsy that found the cancer also showed LCIS.  I have been followed up with mammos every 6 months on the left side and annual MRI's.  Last year after my mammo in Aug they did a needle guided biopsy and again found LCIS.  This 6 months when I went for my mammo the radiologist suggested a surgical biopsy to get wider margins of the area of calcifications.  My husband and I talked with the BS on 8/23/13 and she said even with a surgical biopsy I would still likely to need other biospies in the future and both the ILC and LCIS put me at higher risk of developing it in the right breast.  When I asked about getting a bilateral mastectomy this time, the BS did not discourage it.  She set up an appt for this morning with the PS.  My husband and I saw him and we were very impressed.  Because of the previous radiation I am not really a candidate for the traditional saline implants.  I am in the process of being scheduled for a bilateral mastectomy with DIEP reconstruction.  In all the worry of hearing I needed yet another biopsy (3 so far on the left side and counting!)  I didn't even think to ask about insurance coverage for it.  My husband has BC/BS Federal as he works for the VA.  It sounds like from reading the posts on this topic it should be covered.  I'll just wait to hear from the BS office.

Jill - I definitely agree that it should be covered. My insurer BCBS agreed to a PBMx when I was thought to have "just" ALD, ADH and an extensive family history. Best of luck with your surgery!