How can I get my insurance to pay for a mastectomy?
The Women’s Health and Cancer Rights Act of 1998 requires all group health plans that pay for mastectomy to also cover prostheses and reconstructive procedures. In addition, Medicare covers breast reconstruction, while Medicaid coverage can vary from state to state.
How do you qualify for preventive mastectomy?
You may consider prophylactic mastectomy if you have:
- Already had cancer in one breast.
- A family history of breast cancer.
- Positive results from gene testing.
- Radiation therapy.
Can you get an elective mastectomy?
For women who choose prophylactic mastectomy, several new and important surgical options have become available. It is now possible to remove breast tissue using skin-sparing techniques in which the underlying breast tissue is removed from just under the skin, down to the chest wall.
How much does prophylactic mastectomy cost?
For patients not covered by health insurance, a mastectomy typically costs more than $15,000-$55,000 , not including breast reconstruction. For example, BlueCross BlueShield of Tennessee[2] estimates a cost of more than $15,000 for a bilateral prophylactic mastectomy.
Is mastectomy bra covered by insurance?
Most insurance companies will cover costs for the prosthesis and mastectomy bras, and Medicare will cover them as medically necessary. Patients should get a prescription from their doctor stating their diagnosis and the need for a right or left breast prosthesis and prosthetic bras.
How long do you have to take off work for a mastectomy?
It’s not uncommon to take several weeks off from work while recovering from surgery — both physically and emotionally. The amount of time taken varies from person to person, but usually this ranges between 4 and 8 weeks. When you return to work can also depend on the type of work you do.
What age should I get preventative mastectomy?
Preventive mastectomy is considered appropriate in women aged 25-30 years and above [3]. According to a study by Heemskerk-Gerritsen et al., in women with a breast cancer (BRCA) mutation who underwent bilateral risk-reducing mastectomy, there was 99.6% survival [4].
Is a mastectomy considered major surgery?
Mastectomy is considered a major surgery for the below reasons: The procedure involves permanent removal of either one or both breasts, which itself is a major risk factor. Usually, the procedure may last up to 4 hours depending on the severity of the disease. It is performed under general anesthesia.
Will health insurance cover a double mastectomy?
If a person has cancer in both breasts, original Medicare and Medicare Advantage provide broad coverage for a double mastectomy. The coverage also includes breast reconstruction and prosthesis implantation, in addition to non-surgical treatments, such as chemotherapy and radiation.
Does insurance pay for a breast prosthesis?
A. Yes, your health insurance should cover bras, breast prosthesis, breast forms and camisoles whether you had breast reconstruction if they are medically necessary.
How do you write a prescription for a mastectomy bra?
Mastectomy bra (L8000) used to support the breast prosthesis is covered with a limit of 4 bras per year for Advantage. L8001 & L8002 are non-covered for Advantage. Code L8015 describes a camisole type undergarment with polyester fill used post mastectomy.
Is there an alternative to mastectomy?
A second lumpectomy followed by partial breast re-irradiation (PBrI) was an effective alternative to mastectomy in women who had in-breast cancer recurrence after initial treatment with breast-conserving surgery and whole breast irradiation (WBI), a single-center, phase II study found.
Does insurance cover preventative mastectomy?
Insurance coverage No federal laws require insurance companies to cover prophylactic mastectomy. Some state laws require coverage for prophylactic mastectomy, but coverage varies state to state. It’s best to check with your insurance company to learn about your plan’s coverage. Learn more about health insurance.