Bilateral mastectomy covered?

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LovebeingNana
LovebeingNana Member Posts: 134
edited June 2014 in Employment, Insurance, and Other Financial Issues

Yesterday a woman who works in Human Resources came into my office and said she heard through the grapevine I was "electing" to have a prophylactic mastectomy on my unaffected side and she said "You know if that is just elective insurance won't cover it." This was upsetting 1st because she is going off of what she is hearing through the grapevine, and 2nd because my surgery is scheduled for the 11th and not one doctor or surgeon or anyone has given me any idea this would not be covered!!!!! I am going to call my surgeon when they open later but wouldn't they have told me if their was a possibility of i not being covered? I go to the hosital today for all of my pre op testing.

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  • juneping
    juneping Member Posts: 1,594
    edited March 2014

    not sure what is grapevine. I also believe it is covered usually. It's better you call your insurance company to find out more details. My primary doc told me only very bad insurance doesn't cover this kind of surgery. 

    Before I went for all those doc appts I had a chat with my insurance company and they explained it quite well for me. 

    If they cover the reconstruction it doesn't make sense they don't cover the BMX.

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  • mmtagirl
    mmtagirl Member Posts: 509
    edited March 2014

    The ACS has this on their website and you can direct link if you google "breast cancer reconstruction law".  It is part of the federal law on Women and Cancer Rights.  I would imagine point 2 covers your concern.  As far as I can tell, my prophylactic side has been covered by my insurance.  Hope this helps!

    • Reconstruction of the breast that was removed by mastectomy
    • Surgery and reconstruction of the other breast to make the breasts look symmetrical or balanced after mastectomy
    • Any external breast prostheses ([pros-thee-sees] breast forms that fit into your bra) that are needed before or during the reconstruction
    • Any physical complications at all stages of mastectomy, including lymphedema ([lim-fuh-DEE-muh] fluid build-up in the arm and chest on the side of the surgery)
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  • DiveCat
    DiveCat Member Posts: 968
    edited March 2014

    You have already had the proper answer that it IS covered, but I wanted to just say that I am sorry that you have to deal with someone from Human Resources who is so uninformed and that has caused you such stress so close to your surgery.  Of all the people in your workplace, you think they would be a bit more informed on your insurance coverage, and be able to display some tact and compassion and not going around citing things she heard through the "grapevine". As linked above, surgery and reconstruction on the other breast, whether it is to remove it or to augment it, or whatever else, is covered. Further, in some cases while the surgery is "elective" it is still "recommended" by your medical team (for example, if you have a high risk of cancer in the other breast as well).

    I would hate to see other women in your office have to deal with that woman as well. Is it possible (if you are comfortable with it) to somehow put forward the information on the Women and Cancer Rights legislation to management/HR so that they can well, be actually informed?

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  • Susie123
    Susie123 Member Posts: 804
    edited March 2014

    Wow, how insensitive. I don't consider this to be an elective surgery. My insurance doesn't cover elective surgeries either, but they covered my bmx without question with cancer only in the right breast. Perhaps it's a misunderstanding of what the HR person considers "elective" in her mind, not the insurance companies definition. At the time of my bmx I was covered by my companies insurance plan and as a dependent on my husbands insurance. Both big name national insurance companies that paid without question. You know the Drs office will pre cert the surgery, I would check with them to see what the insurance companies response is. I know I worked for a large corp and the HR people were not allowed to answer questions concerning insurance coverage because they were not qualified. We had to call the insurance company directly, which had a dedicated unit that handled only the company I worked for. 

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  • aunt_paula
    aunt_paula Member Posts: 271
    edited March 2014

    I think you will find that it is covered. I had BMX a few weeks ago, and all they had to go on were mammogram/ultrasound/CT scans, no proven tissue by biopsy because I am allergic to local anesthetics (and because the kind of tumor I was believed to have can't be reliably diagnosed with a core biopsy). My surgeon told me that even without that, there was enough documentation to support medical necessity, and it was precerted with no problem.

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  • LovebeingNana
    LovebeingNana Member Posts: 134
    edited March 2014

    I went in for Pre-op today and they told me it is all pre-approved! Thank you for all of your responses. I agree she was so inconsiderate and I loved the idea of giving her a copy of the law…I put it in her office mailbox

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  • Ariom
    Ariom Member Posts: 6,197
    edited March 2014

    WooHoo! I bet that felt good! Good on you!

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  • aunt_paula
    aunt_paula Member Posts: 271
    edited March 2014

    Yay! So glad it worked out! And I am glad you gave her the copy of the law (partly for her but mostly for you! :).

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  • juneping
    juneping Member Posts: 1,594
    edited March 2014

    yay....i am so happy for you.

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  • positivenegative
    positivenegative Member Posts: 106
    edited March 2014

    I bet if she were getting the surgery she would have known the law.  amazing she is still employed in such a sensitive position when talking through grapevine.  good for you!

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