will insurance cover double mastectomy

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pamalot
pamalot Member Posts: 20
edited October 2014 in Surgery - Before, During, and After

I have dcis in my left breast. I am planning a nipple sparring mastectomy with immediate reconstruction using silicone implant. I an 40 pounds overweight. I am afraid that when I lose the weight my breasts will not be the same size. 12 years ago I lost my sister to breast cancer.

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  • Chrisrenee77
    Chrisrenee77 Member Posts: 1,032
    edited July 2013

    pamalot- my insurance covered my double mastectomy last year. Have your breast surgeon contact your insurance to see if they will cover the prophylactic mastectomy, due to your BC diagnosis. You can always have the non-cancer side either reduced or have an implant placed. I am so very sorry about your sister, it has to be hard losing your sister to BC then come down with it yourself. 

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  • Susie123
    Susie123 Member Posts: 804
    edited July 2013

    I had a double mastectomy with reconstruction in 2010 even though I had cancer in the right breast only. My insurance paid for it. I didn't even think to ask the insurance if they would pay for it, I guess my breast surgeon did when she pre certed the surgery. I had Blue Cross / Blue Shield then.

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  • Maureen1
    Maureen1 Member Posts: 614
    edited July 2013

    (((pamalot))) I had prophylactic bilateral mastectomies after my chemo was done with immediate reconstruction with silicon implants - it all went well and was done in one surgery - Yaay!!! and it was covered completely by my Blue Cross Blue Shield insurance...my plastic surgeon said if I had a mastectomy on the breast cancer side then I could have the same surgery on the other side under Michigan law. I've attached links to the federal law and the laws in each of the states, good luck with you decision...Maureen

    Women's Health and Cancer Right Act:The Women’s Health and Cancer Rights Act (WHCRA) helps protect many women with breast cancer who choose to have their breasts rebuilt (reconstructed) after a mastectomy. This federal law requires most group insurance plans that cover mastectomies to also cover breast reconstruction. It was signed into law on October 21, 1998.

    http://www.cancer.org/treatment/findingandpayingfortreatment/managinginsuranceissues/womens-health-and-cancer-rights-act

    State laws on breast reconstruction: http://www.plasticsurgery.org/reconstructive-procedures/breast-reconstruction/breast-reconstruction-resources/state-laws-on-breast-reconstruction.html

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  • Tinanicu
    Tinanicu Member Posts: 103
    edited July 2013

    I had DCIS and LCIS in one breast and opted for a double mastectomy, my insurance covered it. I also have the BRCA2 mutation, so I don't know if that played a role in coverage or not.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited July 2013

    They have to cover both--BMX and recon. It's the law.

    Claire

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  • pamalot
    pamalot Member Posts: 20
    edited July 2013

    My plastic surgeon said he would have to ask the surgeon. He said there were 2 criteria for a prophylactic mastectomy: the BRC gene or the hormone receptor and I don't have either. I thought having cancer and a sister who died from breast cancer would be enough.

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  • LanaM
    LanaM Member Posts: 142
    edited July 2013

    I asked about a double and my surgeon told me my insurance would probably not cover it - I have Physcians Plus. He said possibly if I had a family history, but I do not.

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  • Chrisrenee77
    Chrisrenee77 Member Posts: 1,032
    edited July 2013

    Lana- I would say call your insurance company yourself. A lot of surgeons don't want to do BMX because they don't feel it necessary. My BS when I went in for consult said here's your options UMX lumpectomy. When she was done I told her that neither of those were my options. I want a BMX, her response "done". Please take control with your insurance company. Unfortunately, some people that don't work in healthcare doesn't know what there policy reads. I work in health are and I fought ALL of my denials with the insurance company. Use the women and breast health act of 1998 and in your case. If you haven't read it please do, they can not deny you for that. My insurance company tries to deny the BRCA testing, the reconstruction, the Oncotype testing there reason my AGE. I told them they could not do that that by federal law. My insurance company came back and approved and paid my claims except the Oncotype. Which was great, I called Myriad and they told me since they had appealed my claims 3 times they finally wrote off all 1600.00 of that claim.

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  • softness1
    softness1 Member Posts: 217
    edited July 2013

    I had a BMX. Only had cancer in one. It's the law. If ur under a certain age, I think mid 40's or something, have close family member that had it or have the gene

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  • grammaB
    grammaB Member Posts: 1,172
    edited July 2013

    Just talked with my ins co. today and got approval for the BMX.  It sure is a load off my mind that I won't have to fight them or worse yet foot the bill!!  They had no answer on the BRACA test, I don't think it has even gotten to them yet for approval, it was just mailed out on Tuesday.  That one may be a problem, but then the main reason I did it was to get more ammunition if I needed it to have the BMX approved.  Now that isn't an issue.  I'd still like to know though....

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  • pamalot
    pamalot Member Posts: 20
    edited July 2013

    I am so frustrated! After taking a day off work to get permission for a BMX even though I only have dcis in the left breast, the surgeon tells me I need permission from the oncologist. I can't see the oncologist until I get an authorization from my primary care physician who will request an authorization from the insurance company. The insurance company will not speak with me directly, only to my primary care physician. I feel like I am being given the run around.

    It is my right to request a BMX,especially since I lost my sister to breast cancer. I am scheduled for surgery in 11 days and approved for only the breast with the cancer.

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  • politicomama
    politicomama Member Posts: 187
    edited July 2013

    I would get another surgeon.  Maybe that is not possible, but they should be willing to follow your wishes.  Why won't the insurance speak with you directly?

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  • pamalot
    pamalot Member Posts: 20
    edited July 2013

    I don't know why the insurance wont speak to me directly. I have family choice. They say it is their policy.

    I am so tired of fighting. And the stress is very hard to take.

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  • danana
    danana Member Posts: 4
    edited October 2014

    Heloooo!

    I have DCIS and refuse radiation therapy.I wanted to ask you about this aspect..

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  • danana
    danana Member Posts: 4
    edited October 2014


    Hi Politico mom!

     

    I see that you did  not have radiation therapy treatment. How  did you base this decision?I wrestle with the system regarding my choice to forgo radiation.My immediate reconstruction has been refused because of my choice. Help!

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