Insurance reimbursement for risk-reducing mastectomy and oophorectomy in women with BRCA1 or BRCA2 mutations

Purpose: Risk-reducing surgery is an important option for women with BRCA1 and BRCA2 mutations. There are reports in the literature that insurance rei mbursement for these procedures varies greatly. Because health insurance co verage significantly affects medical decision-making, current information r egarding 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 o r a risk-reducing oophorectomy between March 1, 1997, and July 30, 2000. Re sults: 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 coinsu rance and deductibles. The rate of insurance reimbursement did not vary wit h type of insurance, personal history of cancer, or type of procedure. Conc lusion: Insurance carriers reimbursed the vast majority of BRCA mutation ca rriers undergoing risk-reducing surgery.