prophylactic coverage

manna1qd
manna1qd Member Posts: 46
edited March 2014 in Breast Cancer #1
Are insurance companies paying for any prophylactic mastectomies? I was under the impression that if my BRCAs were positive that the recommendation is bilateral mastectomy and total hysterectomy. What is the experience out there? Anyone get coverage for a prophylactic without positive gene testing?

Comments

  • seof
    seof Member Posts: 819 Member
    #2
    My insurance did not cover the prophylactic mastectomy, but they will cover the reconstruction (makes no sense to me). You might check the ACS website for any resources to help financially. We had family help, and the Dr. gave us a discount on his services, so we were able to get it done despite the insurance's refusal.
    seof
  • phoenixrising
    phoenixrising Member Posts: 1,508
    #3
    Sorry Manna, I'm in Canada I'm not sure of the coverage in the U.S. Good Luck to you.
    jan
  • mmontero38
    mmontero38 Member Posts: 1,510
    #4
    Hi Manna:
    Some insurance companies will cover them depends on company & type of coverage. You would have to check with your plan. Lili
  • 3cbrca
    3cbrca Member Posts: 206
    #5
    I had bilateral with cancer only in the right and everything was covered - I believe its a State law in MN
  • babs49242
    babs49242 Member Posts: 193
    #6
    My insurance would not cover it in Michigan. I wanted it done but no way..but they would cover reconstruction..weird. Please check with your insurance...I hate 'surpise' costs.
    Cindie
  • Unknown
    Unknown
    #7
    Maybe it depends on what your docs. recommend. I tested negative for brca but beforehand docs. told me that depending on my risk, if I was positive, they would either suggest the mastectomy or frequent surveillance(mamm./ultrasound/MRI). It would depend on my individual risk. If your docs. think the surgery is necessary and wrote a letter, maybe the ins. would cover.
  • ladybluepgh
    ladybluepgh Member Posts: 76
    #8
    HI Manna, I'm trying to find out now in my insurance will cover...no one seems to know and I can't afford to pay for it..soo..i'm just going to keep asking and pushing...just another fight...let me know how it goes for you...ty
  • ladybluepgh
    ladybluepgh Member Posts: 76
    #9
    I just got an answer from my insurance company, they will pay for the prophylactic mast because I have a personal hx of bc...2 primary bc cancers and one when i was premenopausal..so relieved...meeting with the surgeon Feb 19th. I will let you know how it goes.

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