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Is Preventative Mastectomy for Breast Cancer Covered by Medical Insurance?

It is estimated that one in eight women, or approximately 12%, will be diagnosed with breast cancer in their lifetime. However, women with certain genetic mutations have a higher lifetime risk of the disease. It’s estimated that a female BRCA1 carrier has a 60-90% chance of developing breast cancer. They also have an around 40-60% chance of ovarian cancer.[1]

Perhaps the most well-known carrier of the BRCA1 is actress Angelina Jolie, who took the pre-emptive action to minimise risk by having preventative (“prophylactic”) mastectomy to remove both breasts.

I was saddened to recently read a Stuff article telling the story of a woman who was diagnosed with an aggressive form of breast cancer and needed to begin chemotherapy, followed by mastectomy. Doctors advised her to have a double mastectomy because she had tested positive for the BRCA1 gene, placing her at high risk of getting cancer in her other breast. While her medical insurance policy met the cost of chemotherapy treatment and mastectomy of the cancerous breast, it did not meet the cost of the preventative mastectomy of the other breast because the policy was not yet three years’ old! So, the family needed to meet the $25,000 cost for the preventative mastectomy themselves.

This situation highlights the considerable variation in the quality of medical insurance policies in the market. One quality insurer that UProtectNZ works with states that their preventative surgery insurance will meet the cost if:

  • the individual has been diagnosed with breast cancer, and
  • has tested positive for the BRCA1 and/or BRCA2 gene mutation and
  • requires preventative mastectomy of the unaffected breast, and
  • the preventative surgical procedures are recommended as necessary by an appropriate specialist.

Furthermore, their preventative surgery insurance has NO three-year stand-down period.

This woman’s unfortunate situation highlights the importance of working with an experienced insurance adviser to guide you through the maze of options, secure the best cover for you and your family and ensure that you receive fair treatment.

It’s what we do!

[1] https://scienceblog.cancerresearchuk.org/2013/05/14/angelina-jolie-inherited-breast-cancer-and-the-brca1-gene/