Approved: Naperville Woman to Receive Previously Denied Double Mastectomy

Photo: Carmen Severino

“Today, I can smile.”

Carmen Severino, the Naperville woman who was initially denied coverage for a bilateral prophylactic mastectomy the morning of her surgery, has been approved. She will go into surgery Aug. 19.

Severino at first was told the surgery was denied because the hospital stay was too long. Another time she was told it was because BCBS didn’t want to do a bilateral mastectomy and would just take the diseased breast and leave the other one. She also had the option of having both breasts taken but no reconstructive surgery.

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Patch published a story about the morning-of-surgery denial on Friday.

According to BCBS Senior Manager of Media Relations and Public Affairs Mary Ann Schultz, the bilateral prophylactic mastectomy medical policy was in review at the time which led to the contradictory statements Severino was given for denial of coverage.

Now Severino will be able to have both breasts removed and will receive reconstructive surgery for both.

Severino said when she received the phone call from BCBS telling her of the approval, she was told they noticed something they either didn’t see or didn’t have last time that would have helped approve the surgery.

“I thought, well that’s interesting because I just talked to my doctor’s office and they were just getting things ready to send in,” Severino said.

However, Schultz said that medical policies are scheduled for review throughout the year as medical directors review new information on technology, innovations, drugs and more.

According the Schultz, the prophylactic mastectomy policy was on the docket to be reviewed Monday.

“Medical directors discussed the policy and expanded it to include coverage for those with breast cancer in one breast,” Schultz said in an email.

Their decision to expand the policy was not based on Severino’s case.

“This case was not discussed, nor are any specific member cases,” Schultz said. “The medical directors review literature, other policies from leading organizations (and) see what other plans are covering.”

Anyone can see BCBS medical policies and when they were updated and why.

Severino said she’s thrilled and surprised at how fast everything has turned around in her favor.

The days of worry and uncertainty are something she doesn’t want anybody to go through. In order for other people to share their breast cancer stories, Severino has started a Facebook page called Breast Cancer Experience.

“It teaches women how to fight when they’re being bullied by insurance companies or anybody,” Severino said. “I don’t want this to happen to anybody else. It’s devastating.”