Major Insurer Approves Coverage for Breast Cancer Treatment After Investigative Reports

Insurer Policy Change for Breast Cancer Treatment

• 💡 A major health insurance company, Sigma, has changed its policy to now cover Galiflex mesh for breast cancer reconstruction.
• 🎯 This change comes after investigative reports highlighted numerous denials of coverage for this popular treatment.
• 📌 Previously, Sigma considered the use of Galaflex mesh for reconstruction as experimental and investigational, leading to coverage denials.

Impact of Investigative Journalism

• 🚀 The "Patient No More" investigative series, led by reporter Katie Lrron, is credited with bringing attention to the issue.
• 💬 Doctors and patients shared their frustrations and stories of fighting for coverage, influencing the insurer's decision.
• 👏 Dr. Alicia Billington, a plastic and breast reconstruction surgeon, expressed gratitude for the series' instrumental role in achieving this policy update.

Galaflex Mesh and Off-Label Use

• 🔬 Galaflex mesh is a surgical mesh approved by the FDA for use in the body, but its application in breast reconstruction is considered off-label.
• ✅ Surgeons like Dr. Billington find the mesh to be a "game-changer," allowing for better results in a single surgery.
• ⚠️ Despite FDA approval for general use, insurance companies often cite off-label use as a reason to deny coverage for reconstruction procedures.

Ongoing Fight for Coverage

• 📊 Sigma's policy update, effective mid-April, reclassified Galaflex mesh products as medically necessary and effective.
• ⚠️ Efforts continue to update state and federal laws to ensure comprehensive coverage for all breast cancer patients.
• 📞 The investigative team is assisting individuals fighting medical claim denials, having resolved over half a million dollars in disputes.