Medical Insurance and a Prophylactic Mastectomy

asked 1 year ago by chrish1974 in Peace Valley, MO
Latest answer by George J. Beraka, MD
Question viewed 1,242 times
Tags: insurance, mastectomy, medicare, prophylactic

I have a very very strong history of breast cancer in my family.My maternal grandmother died from breast cancer and so has my maternal aunt.My mother was diagnosed at 45 and is still battling it.I also have a sister who has it.I am very set on having this done I have had the gene test done but am the only one in my family to.I have also had 2 lump removels and 2 core biopsies.I am dead set on this will it be hard to get the doc to do it?I also have told my oncologist what I want.Will medicare pay?

8 answers to Medical Insurance and a Prophylactic Mastectomy

Mastectomy and breast reconstruction is covered BY LAW by all insurance companies

If you have breast cancer OR a significant family history of breast cancer, then by law all insurance companies are required to cover whatever cancer surgery you need (i.e. lumpectomy or mastectomy), AND the breast reconstruction option of your choice. If you do an Internet search of "breast reconstruction law" you will come across the legal history and current law from 1998 which describes your rights. Given your family history, I would recommend that your Family Doctor or... more

Karen M. Horton, MD
San Francisco Plastic Surgeon

www.drkarenhorton.com

Prophylactic mastectomies and breast reconstruction are covered by insurance.

Hi. We do this all the time, and our patients get insurance coverage. I don't understand why your doctors would be reluctant to do this.

George J. Beraka, MD
Manhattan Plastic Surgeon

Medicare coverage for prophylactic mastectomy

Based on your family history, I agree that this is an option for you to consider. It is important to consult with a medical oncologist, breast surgeon, and reconstructive surgeon to have them document the medical necessity and indications for this procedure. This should all be submitted to medicare for approval. The process may involve appeals and further letters, but should be covered with the appropriate documentation. I also find that the insurance company... more

Paul S. Gill, MD
Houston Plastic Surgeon

Prophylactic Mastectomy & Reconstruction is covered by Medical Insurance

Your medical insurance should cover the cost of bilateral prophylactic mastectomy and breast reconstruction if you meet of the medical criteria. You should see a breast oncologic surgeon and Plastic surgeon to help you with this situation. This is not a battle to fight by yourself. If you do not get the help you need and deserve, please get another opinion. Good Luck Dr Okoro

Stanley Okoro, MD
Atlanta Plastic Surgeon

www.georgiaplastic.com

Options for prohpylactic mastectomy in high risk patient in Medicaid

There are two issues here: oncologic management of your disease and options for reconstruction. I would consult with your oncologist regrarding an oncologic surgeon willing to perform a prophylactic mastectomy. The reconstruction is another issue. Medicaid may pay for both but the reimbursements are exceptionally low and many surgeons cannot afford to run their practices with these types of payments. Therefore few will participate. You may seek treatment through a University setting.... more

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Medicare Covering Prophylactice Mastectomy

Your breast surgeon should be able to get the appropriate documentation togther to have the surgery covered under Medicare.

Gary D. Breslow, MD
Paramus Plastic Surgeon

Medical Insurance and a Prophylactic Mastectomy

It is a process to have medicare cover a prophylactic simple mastectomy. Very hard but not impossible to accomplish. Find a PS who is willing to "go to bat" for you with Medicare. Regards and good luck Dr. Darryl J. Blinski