TAMPA, Fla. (WFTS) —
Health insurer reverses tune on coverage
Anthem Blue Cross Blue Shield has reversed its policy on covering surgical mesh used in breast cancer reconstruction surgeries, making it one of only two major health insurers in the United States to approve the treatment.
WATCH: Anthem reverses policy on surgical mesh for breast cancer reconstruction
The change follows our year-long investigation into health insurance denials for breast cancer patients.
In a recently updated guideline, Anthem now describes GalaFLEX and two other synthetic surgical meshes as "medically necessary when used for breast reconstruction surgery." The insurer previously denied coverage for the devices, calling them "investigational" and saying there was not "enough proof it improves health."
In a statement, an Anthem spokesperson said the insurer regularly reviews medical literature for updated recommendations and attributed this policy coverage change to "additional studies and more data that recently became available."
Surgical mesh: Popular but controversial
Surgical mesh has become a widely used product among plastic surgeons performing breast reconstruction, but it has not yet been approved by the U.S. Food and Drug Administration for that purpose. Because of that, it is considered an off-label, experimental treatment — a designation most health insurers, including Anthem, have used to deny patients coverage for their surgeries.
Anthem now joins Cigna as the only two major insurers to cover the treatment. Both companies adjusted their policies following our ongoing investigative series on breast cancer treatment denials.
"It's really incedible!"
Breast cancer patient, Beth Clark learned of the policy change from her doctor and said the news moved her to tears. "It's incredible. When Dr. Billington called, I literally teared up, started crying. I mean, I just think it's wow," Clark said.
Clark shared her story publicly with us back in July after Anthem denied her breast cancer reconstruction surgery less than 24 hours before the procedure was scheduled to take place.
Dr. Alicia Billington, a plastic surgeon in St. Petersburg and Clark's doctor, has been advocating for better coverage for breast cancer patients. She said the policy reversals by two major insurers reflect growing pressure from patients and physicians.
"These are pretty big insurance companies that have reversed policy, and I think a lot of it is due to pressure from patients. Patients want these products. Physicians want these products. They work better," Billington said.
Billington said her goal is broader access for all patients.
"I want to make it so that all patients have access to the products and the procedures that they need," she said.
Billington along with the American Society of Plastic Surgeons have been working to modernize the Women’s Health & Cancer Rights Act. The federal law was created to ensure breast cancer patients are covered for the treatments they need at every stage of their cancer journey.
Clark is currently in post-surgery recovery, meaning the policy change will not directly affect her own care. But she is thinking about the breast cancer patients who will benefit — including one of her closest friends, who is about to undergo the same surgery using the same mesh with the same insurer.
"She won't have to have all this extra just ugh around her whole surgery. So, I'm so excited for her and again for all the other women that this will make an impact for. It's really incredible," Clark said.
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Katie LaGrone focuses on making sure Florida’s laws actually work and her investigations have gotten results. If you know of a policy or law that’s not working how it’s intended, send Katie a message below.
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