Nanatwo (original poster member #45274) posted at 8:40 AM on Friday, June 17th, 2022
Does anyone know if Medicare will pay for a double mastectomy if cancer only in one breast? Was diagnosed with breast cancer in 2010 - had lumpectomy and 7 weeks of radiation. I have now been diagnosed with micro invasive ductal carcinoma in situ and will have a mastectomy. I was also diagnosed with uterine cancer in 2010 and my mother died of breast in 1996.
I know insurance sometimes does not pay for a double mastectomy if no cancer in other breast. Didn't know if my medical history would make a difference.
Thanks for any feedback.
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tushnurse ( member #21101) posted at 1:35 PM on Friday, June 17th, 2022
Your oncologist and surgeon need to use appropriate coding to get it covered, if there is a risk of it spreading to the other side, then they absolutely will cover it. That's a hell of a lot cheaper than paying for 2 rounds of surgery and treatment.
Talk to the biller/coder at the oncologist office, and then reach out to MCR if you still have concerns. MCR is pretty generous and often sides on the beneficiary (you).
Stating this as someone who spent 6 years working with MCR and programs to decrease costs, overspending, and poor care.
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ZenMumWalking ( member #25341) posted at 4:45 PM on Friday, June 17th, 2022
Do you have brca1 or brca2? These increase risk of bc in both breasts (and ovaries) - I know more than one person who has had a prophylactic double mastectomy by having this risk genes.
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