IORT and Insurance Coverage

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sailorbev
sailorbev Member Posts: 75
edited April 2015 in Radiation Therapy - Before, During, and After

I am considering IORT but am having trouble finding out if it is covered by my insurance. The surgeon I saw yesterday does not do it and would have to refer me 2 hours away for IORT. I don't want to bother with the consultation if it isn't covered by insurance and my insurance company can't tell me without the billing code. I feel like I am in a Catch-22. Has anyone else has trouble with insurance coverage

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  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited April 2015

    Sailorbev, you can call the second surgeon's office and ask for the necessary CPT code. They should be happy to help you. Good luck!


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  • savgigi
    savgigi Member Posts: 376
    edited April 2015

    Insurance covered mine with no problem. I hope all goes well with your surgery and treatment.

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  • gypsyjo
    gypsyjo Member Posts: 304
    edited April 2015

    I went to the center that offered IORT for a second opinion. When I decided that is what I wanted to do, the second group wrote the proposal including IORT for preapproval to submit to insurance. I also called my insurance and asked to be assigned to a contact there. Not only did they approve the procedure (it is an accepted technology, the real reason that few centers offer it is because of the cost of the equipment), but they covered it and the surgery as if in network. I was advised by my HR group at work to negotiate it upfront. It will also save the insurance company money for the one time treatment vs the standard 6 week treatment. I made sure I mentioned that to my assigned representative. I have been very pleased with the treatment and ease with the approval. Good luck.

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  • sailorbev
    sailorbev Member Posts: 75
    edited April 2015

    Thank you for your responses. savgigi and gypsyjo, are you happy with your choice of IORT?

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  • gypsyjo
    gypsyjo Member Posts: 304
    edited April 2015

    Very happy. I really don't even realize that I have had radiation. The incision is healing cleanly. When my center first started doing the IORT they said they weren't quite as smooth. Now the surgeon removes any skin that may have been damaged on the opening after the radiation treatment. I was #81 at my breast cancer center for the treatment. Two women in the group have had a reoccurrence, which matches with the reoccurrence rate stated and that I found in studies. I would do it again.

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  • savgigi
    savgigi Member Posts: 376
    edited April 2015

    Sailorbev, I was happy with my choice of IORT. I had some side effects. I had a seroma, which can happen but apparently happens more often with IORT. But it was easily drained at my post-op visit. I had a reaction most people do not have - I felt like I was sunburned from the inside out and believe I have some neuropathy as a result. But it is manageable. I should mention I had the full dose. They dose IORT based on the size of tissue removed and I had 43 minutes of radiation during surgery. I guess there should not be a surprise I had some side effects. I am 2 years out and my scar is barely noticeable. I hope all goes well for you.

    My RO said IORT costs about 1/3 of what regular radiation costs.

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