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Current national health insurance coverage policies for breast and ovarian cancer prophylactic surgery.

Publication ,  Journal Article
Kuerer, HM; Hwang, ES; Anthony, JP; Dudley, RA; Crawford, B; Aubry, WM; Esserman, LJ
Published in: Ann Surg Oncol
June 2000

BACKGROUND: The efficacy of prophylactic mastectomy and oophorectomy in reducing breast and ovarian carcinoma has recently been reported in high-risk women. Because cost has become central to medical decision-making, this study was designed to evaluate currently existing coverage policies for these procedures. METHODS: A confidential detailed cross-sectional nationwide survey of 481 medical directors from the American Association of Health Plans, Medicare, and Medicaid was conducted. RESULTS: Of the 150 respondents, 65% (n = 97) had 100,000 or more enrolled members and 35% (n = 53) had fewer than 100,000 enrolled members. Only 44% of private plans have specific policies for coverage of prophylactic mastectomy for a strong family history of breast cancer and 38% of plans for a BRCA mutation. Only 20% of total responding plans had a policy for coverage of prophylactic oophorectomy under any clinical circumstance. Governmental carriers were significantly less likely to have any policy for prophylactic surgery (range, 2%-12%) compared with nongovernmental plans (range, 24%-44%; P < .001). No significant regional differences for coverage policies were identified (P > .05). CONCLUSIONS: Significant variations currently exist for health insurance coverage of prophylactic mastectomy and oophorectomy. As genetic testing becomes widespread, more uniform policies should be established to enable appropriate high-risk candidates equal access and coverage for these procedures.

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Published In

Ann Surg Oncol

DOI

ISSN

1068-9265

Publication Date

June 2000

Volume

7

Issue

5

Start / End Page

325 / 332

Location

United States

Related Subject Headings

  • Transcription Factors
  • Risk Factors
  • Patient Selection
  • Ovariectomy
  • Ovarian Neoplasms
  • Oncology & Carcinogenesis
  • Neoplasm Proteins
  • Mastectomy
  • Insurance, Health
  • Insurance Coverage
 

Citation

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Kuerer, H. M., Hwang, E. S., Anthony, J. P., Dudley, R. A., Crawford, B., Aubry, W. M., & Esserman, L. J. (2000). Current national health insurance coverage policies for breast and ovarian cancer prophylactic surgery. Ann Surg Oncol, 7(5), 325–332. https://doi.org/10.1007/s10434-000-0325-1
Kuerer, H. M., E. S. Hwang, J. P. Anthony, R. A. Dudley, B. Crawford, W. M. Aubry, and L. J. Esserman. “Current national health insurance coverage policies for breast and ovarian cancer prophylactic surgery.Ann Surg Oncol 7, no. 5 (June 2000): 325–32. https://doi.org/10.1007/s10434-000-0325-1.
Kuerer HM, Hwang ES, Anthony JP, Dudley RA, Crawford B, Aubry WM, et al. Current national health insurance coverage policies for breast and ovarian cancer prophylactic surgery. Ann Surg Oncol. 2000 Jun;7(5):325–32.
Kuerer, H. M., et al. “Current national health insurance coverage policies for breast and ovarian cancer prophylactic surgery.Ann Surg Oncol, vol. 7, no. 5, June 2000, pp. 325–32. Pubmed, doi:10.1007/s10434-000-0325-1.
Kuerer HM, Hwang ES, Anthony JP, Dudley RA, Crawford B, Aubry WM, Esserman LJ. Current national health insurance coverage policies for breast and ovarian cancer prophylactic surgery. Ann Surg Oncol. 2000 Jun;7(5):325–332.
Journal cover image

Published In

Ann Surg Oncol

DOI

ISSN

1068-9265

Publication Date

June 2000

Volume

7

Issue

5

Start / End Page

325 / 332

Location

United States

Related Subject Headings

  • Transcription Factors
  • Risk Factors
  • Patient Selection
  • Ovariectomy
  • Ovarian Neoplasms
  • Oncology & Carcinogenesis
  • Neoplasm Proteins
  • Mastectomy
  • Insurance, Health
  • Insurance Coverage