Will my insurance cover my breast cancer surgery?

Will my insurance cover my breast cancer surgeryThe financial burden of health care is a subject that cannot be overlooked. As if the emotional and physical stresses of an illness are not enough, the rising costs of healthcare can only increase the burden on the patient. By ensuring your policy adequately covers comprehensive screenings for early detection and appropriate treatment, you will be one step ahead in relieving the financial tensions during treatment for breast cancer. Understanding your policy is also key so you can be confident in the coverage you would receive, before you actually need it. For optimal coverage, you want to ensure your policy includes the following:

  • Screening and Diagnostics – The law requires every health plan to cover costs associated with routine mammogram screenings for women over age 40 and possibly younger if there is a family history of breast cancer. You should also verify your coverage includes diagnostic mammograms, MRIs, ultrasounds, CT scans and other diagnostic exams that could be ordered by your physician.
  • Treatment – Your health care plan should include coverage for breast cancer treatments, including mastectomy, partial mastectomy or lumpectomy, and radiation. If your plan covers a mastectomy, it is required by law your plan also cover prostheses and/or breast reconstruction for both breasts even if cancer is only present in one.
  • Prescriptions – Most insurance plans offer prescription drug coverage and cover an increased amount of the cost for FDA-approved drugs. Some medications, such as chemotherapy, can be very costly so you may want to consider investing in a supplemental prescription drug plan.
  • Second Opinions – When a significant health issues is at hand, such as breast cancer, it is often wise to get a second opinion regarding treatment. Most insurance companies will cover a second opinion and even a third if the first two differ in view.
  • Genetic Counseling and Testing – Most insurance companies will cover a portion of genetic testing if you are at risk for hereditary illnesses, such as breast cancer. It is more cost effective for insurance companies to have a proactive approach to treatment should you discover you have the BRCA mutation. If you are at risk for hereditary breast cancer, talk with your primary care physician about a referral to a genetics counselor for testing.

The Family and Medical Leave Act protects your job and health care benefits for up to 12 weeks of unpaid leave should you not be able to work during treatment. Depending on your employee benefits and/or individual policies, you may also be eligible for short or long-term disability benefits, Social Security Disability, or your state’s Supplemental Security Income.

Health insurance is a complex business. Choose a plan you can afford as well as a provider willing to work with you in the process of filing claims and countering denials. Always follow the rules specific to your plan in regards to preauthorization as opposed to obtaining coverage after the fact. It is also extremely helpful to obtain written referrals to any provider outside of your primary care physician.

Premier Surgical Associate’s offers patients innovative, state-of-the-art breast care. Our team is dedicated to timely diagnosis and comprehensive treatment for all breast problems. To learn more about Breast Cancer Surgery with Premier Surgical Associates visit our website.

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