Ins deny coverage after recurrence of DCIS without rads

pnmg02 · September 2012

I was diagnosed with Stage 0 Grade 2 DCIS after microcalcification on a mamo. After lumpectomy on Aug 17 no other cancer was found clear margins. BS said I was in gray area of rads or not. RO says the NCCN recommends rads and with it I have 2-3% of recurrence without a 10% chance of recurrence. RO says it would not be unreasonable for me to decline and he would back me. My question is has anyone chosen not to do rads or hormone therapy had a recurrence and insurance refused to pay for treatment at that time? And, also has anyone with similar circumstances had a recurrence.

thanks in advance to all the strong, brave women and men on this community

peggy_j · September 2012

Interesting question. In all my reading about health insurance problems (and watching movies like Michael Moore's SICKO) I don't think I've ever heard of anyone being denied a claim because their previous Tx wasn't considered aggressive enough. If you're concerned about this, is there an impartial insurance expert you can ask? In California, there's a government agency to help consumers with health insurance issues. The person I spoke to was very knowledgeable and also willing to be frank. Maybe your cancer support center (or your doctor's social worker) would have a lead to a similar expert for your state.(I found the phone number on a *.gov website)

FWIW, a 10% risk of recurrence seems relatively low to me, especially when you consider that every Tx has possible short- and long-term SEs. You could also get a second opinion.

pnmg02 · September 2012

Peggy

Thanks for the reply. That is a good idea to talk to insurance person at the cancer center. Thanks again for the info.

Ins deny coverage after recurrence of DCIS without rads

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