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Goddess Forever
Posts: 736
Reply with quote  #1 
Apparently, BCBS isn't a big fan of contralateral prophylactic mastectomies... They want my MD to go through a sort of preapproval process.  So... without being BRAC+, what should I ask him to include in the letter??  Frankly, he *doesn't* think it is medically necessary but said he'd do the procedure (and write the letter if I give him my justifications).  My oncologist *does* think it is medically necessary so he said he'll do a letter but the "request" for approval has to come from my surgeon.

Help me!!!


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Posts: 7,476
Reply with quote  #2 
Michele, all the insurance companies say they don't like to do prophys but they ultimately have to do them in the end.
Your onc should write a letter and your surgeon needs to be made aware that THIS IS YOUR WISH AND HE HAS TO HELP YOU.  I would make your onc have a little chat with him so they are on the same page.
They gave me all sorts of problems approving every stage of my masts and recon, but in the end, the law is on our side.

Hugs to you,




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Goddess Forever
Posts: 2,525
Reply with quote  #3 
There are lots of reasons, I went insane feeling my breasts up and down all day long, they had to be cut off, either by the BS or by me personally.....
They are afraid to slapped with a suit if you change your mind so they won't tell you 'do it' up front, it is all a bunch of crap if you ask me.....
I told them the bill for (my) psychiatric care will outweigh any mastectomy by far, if they don't comply!
Having a higher risk cancer is reason enough too, I thought.
Gosh, what stress.....a BS is not an oncologist, they cut, they don't 'treat' per say.......right?

~ There are lies, damned lies and statistics ~

Goddess Forever
Posts: 1,218
Reply with quote  #4 

I guess I was the time of Dx, both the surgeons, I interviewed suggested/recommended that I do a bilat....I was not a candidate for lumpectomy on bc side as there was so much of my questions for the surgeons was bilat and they beat me to it with their recommendation before I could even ask the question.  And after the mastectomy and pathology came back, I was told that it was a good thing that I did the bilat as the prophy side was pre-cancerous and I would be going down the bc road again if I had not done bilat....okay enough about my story.

I would ask your onc to talk to the BS and have the the onc tell the BS what to write...why it is medically necessary to do the prophy....and a 2nd letter maybe from the onc might not hurt.

You shouldn't have to fight this battle....having BC is hard deserve the best and if a prophy is what you want/need then that is the best for you.  Hope the insuranve company complies quickly.



Posts: 1,940
Reply with quote  #5 

Here is the link for the law that says your insurance company
has to cover this. If they cover mast then they must cover
all things related to and including making you symmetrical.
 So I say have him include the law. insurance companies make me so mad sometimes! Let everyone know you know your rights. I gave my insurance company a call when I was trying to get my PBM approved. Print the law out and hand it to em!


courage does not always roar. sometimes courage is the quiet voice at the end of the day
saying.. i will try again tomorrow.
~maryanne radmacher
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