Private v. NHS - is it more difficult to get funding for preventive surgery?

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Hello All,

This is my first post so a little anxious!

I am coming to the end of my chemotherapy for a Grade 3, HER+ breast cancer.

I have a family history of ovarian cancer and breast cancer (still waiting for BRCA gene test results). In view of this, I would prefer a bilateral mastectomy.

For the first time ever, I have had private medical cover as a perk of my job and I have been treated privately; in practice there has been no significant difference in my treatment compared to my friends on the NHS at the same hospital.

However, I do have a concern about private funding when I request mastectomy of the healthy side too. Although this seems to be met as an acceptable and reasonable request on the NHS; is it different when one is a private patient?

Does anyone have experience of this? Have you had any problems with funding?

Thanks,

Marisa

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I would talk it over with your surgeon - if he/she thinks it is a good idea then may contact your insurance on your behalf.
Or you could phone them and ask if, in theory, they would fund it.
I too had medical insurance and had all my treatment through it, and although I’m not in the same situation as you (no family history), I have been told by insurance that they would fund reconstruction/reduction.
I’d ask - then at least you know.
Good luck with it!!!

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Thank you Soprano, my insurers have said they may consider preventive surgery.

I think any request would be better coming directly from my consultant. I see him next week but was interested to hear if anyone had had any problems.

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I had to argue my case quite forcibly with our insurers, but they did agree to pay eventually. I was amazed that they would have happily paid for me to have reconstruction (which I didn’t want), and which would have cost them substantially more money, and would have offered me no protection whatsoever. But they quibbled over the cost of a prophylactic mastectomy…fortunately, common sense prevailed, but I did have to argue my case for quite a while. Good luck!

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Elaine, thank you for your post.

I think the surgeons will have to make the case with my insurers.

Does anyone else have any experience of this issue?

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Hi marisa

i dont have experience with this specific issue - but plenty with PPP, in any contentious thing they are going to want your consultants detailed opinion at some point …so you are defintely right that your surgeon will have to make the case, they will have experience doing this - so why not bring them in at early stage, it will save you alot of hassle in talking to very junior claims people who will only state the usual bureaucratic blah blah,

good luck
cathy