Ask the Doctor- Will My Insurance Cover a Prophylactic Mastectomy If I’ve Had Gene Testing?

This week, James E. Craigie, MD, of The Center for Natural Breast Reconstruction answers your question.

Question: I did the gene testing in February; tested positive for BRCA 2. I want to go full steam ahead and be proactive with prophylactic mastectomy. I am 31-year-old single mom. However, in regards to insurance, I am in a pickle. I just switched jobs and will be obtaining new/different insurance with new company. Will the new insurance I am obtaining most be okay with the gene testing from prior company and proceed to pay for the mastectomy/reconstruction? I can provide all the results and positive test results as well to them to suffice.

Answer: Most insurances do pay for prophylactic mastectomies when you have a gene conferring increased risk. While I cannot tell you with certainty, the companies that offer the tests are pretty standardized, and there is no logical reason not to accept the results of a prior test. We would be happy to help you further define your options with your present insurance company, if you wish.

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