Insurance reimbursement for risk-reducing mastectomy and oophorectomy in women with BRCA1 or BRCA2 mutations.
OBJECTIVE
Risk-reducing surgery is an important option for women with BRCA1 and BRCA2 mutations. There are reports in the literature that insurance reimbursement for these procedures varies greatly. Because health insurance coverage significantly affects medical decision-making, current information regarding reimbursement practices of third-party payers is needed.


METHODS
Retrospective study of hospital billing records of 38 women with documented BRCA1 or BRCA2 mutations who underwent either a risk-reducing mastectomy or a risk-reducing oophorectomy between March 1, 1997, and July 30, 2000.


RESULTS
Complete billing and reimbursement information was available for 35 women undergoing a total of 39 risk-reducing surgeries. A total of 38 of 39 (97%) risk-reducing surgeries were covered in full, less applicable coinsurance and deductibles. The rate of insurance reimbursement did not vary with type of insurance, personal history of cancer, or type of procedure.


CONCLUSIONS
Insurance carriers reimbursed the vast majority of BRCA mutation carriers undergoing risk-reducing surgery.
Kauff
N D
ND
Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Scheuer
L
L
Robson
M E
ME
Glogowski
E
E
Kelly
B
B
Barakat
R
R
Heerdt
A
A
Borgen
P I
PI
Davis
J G
JG
Offit
K
K
D000328:Adult; D024682:BRCA2 Protein / Q000235:genetics; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery; D003657:Decision Making; D005260:Female; D019398:Genes, BRCA1; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D006579:Heterozygote; D006753:Hospital Records; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D008329:Managed Care Programs / Q000191:economics; D008408:Mastectomy / Q000191:economics*; D008875:Middle Aged; D009154:Mutation; D009518:New York; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery; D010052:Ovariectomy / Q000191:economics*; D012189:Retrospective Studies; D012307:Risk Factors
D024682:BRCA2 Protein