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Topic: Insurance Coverage with a mutation and only 1 relative with BC?

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

Posted on: May 15, 2019 08:17PM - edited May 15, 2019 08:18PM by nmprovo

nmprovo wrote:

I am positive for a mutation in the BARD1 gene (which is considered a moderate-risk for breast cancer) and my only family history is my maternal great-grandmother who had breast cancer twice at the age of 74 and 77. I am moving forward with a prophylactic mastectomy (mostly because of all my unknown family history) and my breast surgeon obviously doesn't think it'll be a problem to get it covered or I'm sure she would have said something. But I'm just so scared they are going to deny it. Has anyone had theirs covered with a moderate risk gene (or no gene) and limited family history? I have UHC if anyone has that.

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May 16, 2019 11:14AM vlnrph wrote:

I have not had experience with this particular type of situation but would suggest you ensure that the doctor and hospital contact your insurance company in order to obtain prior authorization for any type of 'elective' surgery otherwise you might be held accountable for the entire bill. You should be able to look at your policy on line and see whether exclusions exist or what the parameters for medically necessary procedures are.

With smaller families these days, a deleterious mutation for hereditary breast or ovarian cancer (HBOC) may hide for generations as it is passed through male ancestors which means yours is a reasonable choice. However, risk reducing is probably better terminology than prophylactic/preventive for mastectomy in this case because not all tissue can be removed. So, you still run a very small chance of having a tumor develop.

Hopefully everything will go well and you can rest assured that you did all you could. Is your genetic counselor helping to inform any family members who might also be affected?

IDC too! 🎻💊👪🐩 🇫🇮 🌹🦋 Rt MX+DIEP 4-2011; ALND 5-2011 d/t micromets; TC X 4; tamoxifen; lymphedema 9-2011; switch to letrozole 3-2014 for 1 yr; bone mets 8-2018: Zometa, rads to spine, Faslodex/Versenio Dx 3/7/2011, ILC, 2cm, Stage IIA, Grade 2, 1/25 nodes, ER+/PR+, HER2-

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