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Insurance coverage for prophylactic surgeries?

Page last modified on: October 7, 2008
Question from Ang: I am concerned about the cost of elective surgery. Will my insurance cover the cost of removal of breasts and/or ovaries?
Answers —Beth DuPree, M.D., F.A.C.S.: If the woman's risk is such that prophylactic surgery has been suggested by either her surgeon or medical oncologist, I have found that most insurance companies will provide coverage for that surgery as it is not considered elective but prophylactic. I personally would not perform a prophylactic surgery on a patient who did not have significant risk of breast or ovarian cancer.
Lynn Hartmann, M.D.: I agree with Dr. DuPree. Occasionally the insurance companies will balk at reimbursement, but if the physician provides documentation of the need for the surgery, they usually do provide coverage.

On Wednesday, February 15, 2006, our Ask-the-Expert Online Conference was called Risk Reduction. Lynn C. Hartmann, M.D. and moderator Beth Baughman DuPree, M.D., F.A.C.S. answered your questions about a variety of topics such as screening with mammograms, MRIs, and ultrasounds; breast biopsies; lifestyle changes that make a difference; and making hard decisions about prophylactic surgeries.

The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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Meet the Experts

Lynn C. Hartmann, M.D.Lynn Hartmann, M.D. is a professor of oncology at the Mayo Clinic and associate director for education of the Mayo Clinic Cancer Center.

Beth Baughman DuPree, M.D., F.A.C.S.Beth Baughman DuPree, M.D., F.A.C.S. is a general surgeon. Her clinical practice is located at Holy Redeemer Hospital and St. Mary Medical Center.

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