Oopherectomy and Insurance Coverage

Last Modified: November 1, 2001

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Question
Dear OncoLink "Ask the Experts,"
My present health insurance company will not cover a proposed bilateral oopherectomy even though my mother and mother's mother died from ovarian cancer. They did cover one lady's surgery in this area, then refused to cover any more. Do you have any suggestions?


Answer
Key issues are whether you are being treated fairly, and whether you can convince your insurance carrier that you may be at an increased lifetime risk of developing ovarian cancer.

We suggest that you initially write to the Medical Director of your health plan asking them to document the specific criteria they utilize to determine eligibility for the procedure. In addition, request that they delineate the specific reasons you were denied access to this service. Carbon copy your respective state's Insurance Commisioner on all correspondence related to this matter.

We have a document on OncoLink from Penn Today entitled "Breast, Ovarian Cancer Risk Evaluation" that is available as a pdf file. This article describes risk assessment for breast and ovarian cancer. The influence of family history and the BRCA1 gene are included. The role of prophylactic surgery is addressed. This information may be helpful when you prepare a letter for the Medical Director of your health plan.

In addition, letters or consultation reports from recognized programs and experts would certainly be compelling. Many such programs exist. You may be interested in contacting the Penn Cancer Risk Evaluation Program at 215-898-0247 or 1-800-789-PENN. Perhaps the results of an evaluation through this program would be convincing to your insurance company.




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