NEW YORK (WABC)– There’s a new procedure to help women who have a mastectomy continue to feel sensation in their chest, but Eyewitness News found not all insurance companies will cover it.
The procedure, called nerve grafting, involves using nerve tissue to fill a gap between damaged nerves, restoring sensation. During a mastectomy, nerves may be severed and some patients may have permanent numbness in the chest.
Nerve grafting is a surgical technique that has been around for years, but has only recently been applied in breast reconstruction. Few studies have been done on the effectiveness of the breast reconstruction procedure after mastectomy.
“We’re still at the beginning of the curve — that’s part of the problem,” said breast reconstruction surgeon Dr. Tommaso Addona of New York Plastic Surgical Group.
Addona said women who have undergone nerve grafting during breast reconstruction report higher levels of satisfaction with their reconstruction and better quality of life.
Addona said the study of nerve grafting in breast reconstruction is currently a major question for surgeons caring for breast cancer patients.
“We’re working on technical options – or opportunities – that can better assess a patient’s sensation and responsiveness after surgery, so we can kind of bring those numbers down and have a better understanding of our baseline so we can show the improvement,” he said.
Sarah Morelli contacted Eyewitness News because her insurance company – Cigna – did not cover the procedure.
Morelli’s two aunts were diagnosed with breast cancer at a young age, and her mother died of breast cancer at age 39.
“I grew up without my mother and I have two young boys and I don’t want to have to go through that,” she said.
Morelli wants to undergo a preventative double mastectomy with nerve graft.
“I would love to be able to hold my children and feel them against me and feel sensations on my skin, even just to be safe, so I don’t get burned when I lean against something,” she said. she declared.
However, Cigna does not cover nerve grafting for any conditions.
“It is absolutely ridiculous to me that my health care is determined not by my trained medical provider, but by my insurance company,” Morelli said. “I don’t want that for other women.”
Cigna said in a statement to Eyewitness News: “We are committed to ensuring our customers have affordable coverage and access to the full range of mastectomy and breast reconstruction procedures, as well as surgeons from quality who perform these complex surgeries. Our coverage decisions are guided by the latest medical literature and clinical evidence, and we regularly review our coverage policies as new evidence is published. Currently, there is insufficient clinical evidence to support the safety and effectiveness of nerve transplantation using allograft for any condition. If a client and their physician believe that an investigational, investigational, or unproven procedure is medically necessary, they may appeal our decision.
Cigna is not the only insurance company that does not cover nerve grafting for breast reconstruction after a mastectomy.
Anthem Blue Cross considers this policy not medically necessary and states in its policy that additional study is necessary.
Aetna does not consider the procedure medically necessary, but includes positive studies on the procedure in its policy, saying more research is needed.
Eyewitness News contacted Anthem Blue Cross and Aetna about their policies, but they did not respond.
Health insurance centers & Medicaid told us that health officials have not issued a ruling regarding post-mastectomy nerve grafting for Medicare patients. Each Medicare administrative contractor would determine whether a service is covered on a case-by-case basis.
Medicaid patients can check if the Medicaid program would cover nerve grafting after a mastectomy by contacting their state Medicaid agency.
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