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Angelina’s Surgery: Covered by Insurance?

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By Lisa ZamoskyMarch 31, 2015
From the WebMD Archives

Last week, Angelina Jolie wrote her second op-ed in two years for the New York Times explaining her choice to have an elective surgery to lower her risk of getting cancer.

She had her ovaries and fallopian tubes removed. Two years prior she underwent a preventive double mastectomy.

In addition to her mother, grandmother and aunt all having cancer, Jolie revealed that a blood test showed she carried a mutation in the BRCA1 gene, which gave her an estimated 87% risk of breast cancer and a 50% risk of ovarian cancer. Her two surgeries would dramatically reduce her chances of getting either form of cancer, she writes.

Estimates are that nearly one million Americans have a BRCA1 or BRCA2 gene mutation that leads to a higher cancer risk. About 90% don’t know they carry the mutation, says Lisa Schlager, vice president of Community Affairs & Public Policy for the advocacy organization, Facing Our Risk of Cancer Empowered (FORCE). Preventive surgery can reduce the risk of getting cancer by 95%.

Jolie has shed light on the options available to people who are at high risk of developing cancer. But in the end, procedures used to treat disease are only as useful to us as our ability to pay for them. For most of us, that means if our health plan doesn’t cover part or all of the cost of care, we may be forced to delay or forego treatment.

If you or a loved one is considering surgery as a way of preventing cancer down the line, can you expect your health plan to cover the cost? Schlager of FORCE shares information about what you can expect.

Coverage for testing is spotty. Preventive surgery typically first requires genetic testing to confirm whether you’re at particularly high risk for getting breast and/or ovarian cancer.

Under the Affordable Care Act, insurance companies are required to cover the entire cost of genetic counseling and BRCA testing in women who have a strong family history. The cost is covered in full for preventive care only. “Once a woman has cancer it’s no longer considered prevention,” she says.

If you wish to be tested to learn if you’re at high risk for another cancer diagnosis down the line you may be on the hook for the full cost. You need to check directly with your insurer.

Also, even though men may carry mutated BRCA genes, insurance is unlikely to pay for their tests.

Help paying for testing is available. If your health plan won’t cover testing, you can go directly to a lab and pay out of your own pocket. Costs vary from several hundred dollars to more than $ 4,000, depending on the specific test and which lab conducts it. You can search the FORCE website for a list of labs that perform BRCA genetic testing.

If you pay out-of-pocket, Schlager says often labs will work with you to reduce the price. Also, you may be able to get financial help from organizations, such as the Cancer Resource Foundation.

Some surgeries are covered. If preventive surgery turns out to be your best option, there’s a good chance your insurer will cover it, assuming you meet criteria.

Schlager says removing ovaries and fallopian tubes are covered more regularly than preventive mastectomies. That’s because unlike mastectomies, removing the ovaries reduces the risk of both breast and ovarian cancer. In addition, doctors are much better at detecting breast cancer early when it can be successfully treated, than ovarian cancer, which is often detected in late stages.

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