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Topic: Anyone denied by insurance for prophylactic mastectomy

Forum: High Risk for Breast Cancer — Due to family history, genetics, or other factors.

Posted on: Apr 19, 2019 08:52AM

Ja9831 wrote:

Hi all!! I have a family history of bc my mother died of bc and my grandmother had it as well. I was just diagnosed with LCIS which was found on accident after a lumpectomy of a intraductal papilloma. My question is has anyone been denied by insurance for a prophylactic double mastectomy? I understand that it’s not considered bc now. I don’t want to do the meds and the follow ups till possibly something is eventually found. I just want them off.

Dx 4/8/2019, LCIS, Left
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Apr 19, 2019 09:39AM MelissaDallas wrote:

You will probably be covered, but you need to check with your insurance company. Some of them post their guidelines on covering high risk prophylactic mastectomy on their websites.

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor.
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May 3, 2019 12:59PM SimoneRC wrote:

Hi Ja9831,

I believe that if you have an ATM gene mutation that PBMX would be covered. Not sure if it is a VUS of ATM.

Good luck and let us know how everything goes!

ATM Gene Mutation, Deletion. IDC w/Lobular Features and Focal Mucinous Features. Pre Pectoral Reconstruction. Hysterectomy Surgery 4/6/2018 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 5/6/2018 Arimidex (anastrozole) Surgery 7/3/2018 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 4/30/2019 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 4/30/2019 Prophylactic ovary removal Surgery 8/6/2019 Reconstruction (left): Fat grafting; Reconstruction (right): Fat grafting

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