Isurance denied for a BMX with DCIS diagnosis in one breast

Spiritedcharm · August 2018

Has anyone had a claim denied for BMX with a DCIS diagnosis in one breast?I was recently diagnosed with DCIS in one breast and the area is small. Due to family history and other issues, I've made the decision to have a BMX with reconstruction. I haven't even met with the surgeon, so nothing is in motion yet. This is giving me time to worry about the financial aspect of it. I had a dream last night that my insurance (Anthem) denied it, saying a lumpectomy is all they would pay for! I really hope that's not a possibility

Lula73 · August 2018

By federal law they cannot deny you a bmx or whatever type of recon you desire (implants or natural tissue recon). Here’s a link to a great video discussing mx and recon that compiles everything you need to know and everything you didn’t know you needed to know. There’s a part 2 link at the end.

https://www.breastcenter.com/2018/05/01/i-wish-id-known-dr-ordonye-speaks-to-ypo-about-modern-breast-cancer-care/

Spiritedcharm · August 2018

Thank you so much! That's a relief!

I_Spy · August 2018

I can't imagine that ever happening. If you're surgeon says it is medically indicated, I think it would be approved. In fact, I had Anthem when I had my BMX for DCIS and family history. There are so many things to worry about with this process, don't worry about that!

buttonsmachine · August 2018

Have your doctors and care team work it out with the insurance company - they know how to make things happen.

I was denied a couple things - one MRI and one surgery. (Both were completely necessary, by the way.) The MRI was delayed somewhat, but I got it. The doctors went ahead and did the surgery because it was urgent, and worked it out with insurance after the fact. The doctors/hospital had to make some calls and submit some papers, but in the end my insurance company acquiesced and covered everything.

Hope you get the care you need.

I_Spy · August 2018

buttonsmachine she just had a dream that she was denied surgery -- she wasn't actually denied.

buttonsmachine · August 2018

Oh phew! Somehow I glossed over that part. 😜

I think I've seen too many crazy insurance situations - I didn't even bat an eye!

I_Spy · August 2018

I know I did the same thing! It has happened, so it was not outside the realm of possibility!

Isurance denied for a BMX with DCIS diagnosis in one breast

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