Reports from University of Maryland Advance Knowledge in Prophylactic Mastectomy (Insurance Coverage of Prophylactic Mastectomies: a National Review of the United States): Surgery – Prophylactic Mastectomy

2023 MAR 10 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Data detailed on Surgery - Prophylactic Mastectomy have been presented. According to news reporting out of Baltimore, Maryland, by NewsRx editors, research stated, “Prophylactic mastectomy (PM) may be a suitable risk-reducing procedure. However, there are substantial discrepancies between national society recommendations and insurance company requirements.”

Our news journalists obtained a quote from the research from the University of Maryland, “Onehundred insurance company policies on PM were evaluated, yielding significant variability in both indications and medical necessity criteria between insurers. The decision to undergo a PM must be carefully considered and should not be influenced by insurance coverage. Breast cancer is associated with a multitude of risk factors, such as genetic predisposition and mutations, family history, personal medical history, or previous radiotherapy. A prophylactic mastectomy (PM) may be considered a suitable risk-reducing procedure in some cases. However, there are significant discrepancies between national society recommendations and insurance company requirements for PM. The authors conducted a cross-sectional analysis of insurance policies for a PM. One-hundred companies were selected based on the greatest state enrolment and market share. Their policies were identified through a Web-based search and telephone interviews, and their medical necessity cr iter ia were extracted. Preauthorized coverage of PMs was provided by 39% of insurance policies (n = 39) and 5 indications were identified. There was consensus amongst these policies to cover a PM for BRCA1/2 mutations (n = 39, 100%), but was more variable for other genetic mutations (15%-90%). Coverage of PM for the remaining indications varied among insurers: previous radiotherapy (92%), pathological changes in the breast (3%-92%), personal history of cancer (64%) and family history risk factors (39%-51%). There is a marked level of variability in both the indications and medical necessity cr iter ia for PM insurance policies.”

According to the news editors, the research concluded: “The decision to undergo a PM must be carefully considered with a patient’s care team and should not be affected by insurance coverage status.”

This research has been peer-reviewed.

For more information on this research see: Insurance Coverage of Prophylactic Mastectomies: a National Review of the United States. Clinical Breast Cancer, 2023;23(2):211-218. Clinical Breast Cancer can be contacted at: Cig Media Group, Lp, 3500 Maple Avenue, Ste 750, Dallas, TX 75219-3931, USA. (Elsevier - www.elsevier.com; Clinical Breast Cancer - http://www.journals.elsevier.com/clinical-breast-cancer/)

Our news journalists report that additional information may be obtained by contacting Emily R. Finkelstein, University of Maryland, School of Medicine, Dept. of Surgery, Division of Plastic Surgery, Baltimore, MD, United States. Additional authors for this research include Michael Ha, Ledibabari M. Ngaage, Marissa Klein, Annie Yanga, Sheri Slezak, Yvonne M. Rasko, Shannon M. Colohan, Suliat M. Nurudeen and Julia H. Terhune.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1016/j.clbc.2022.12.001. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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