Aug. 20--It's been an up and down couple of weeks for Carmen Severino.
The 60-year-old Naperville resident was diagnosed with right breast cancer in February. After months of chemotherapy, she opted to undergo a bilateral mastectomy and have both her cancerous and healthy breast removed and reconstructed.
"For my peace of mind, just take them both," the married mother and grandmother said. "Why wait and have something happen two or three years down the road, and go through chemo again? I can't go through chemo again."
Her surgery was delayed, however, because Blue Cross and Blue Shield of Illinois initially would not cover the removal of her healthy breast, a procedure known as a contralateral prophylactic mastectomy.
"I was devastated," said Severino, who shared her story on social media at https://www.facebook.com/breastcancerexperience. "I took to my bed for two days, just crying, and really scared."
But a week later, on the afternoon of Aug. 12, Blue Cross and Blue Shield approved the coverage, saying the company updated its policy to cover contralateral prophylactic mastectomy. She had the surgery Aug. 19.
Severino's husband, David Eisen, said Thursday that the surgery went well, and that no evidence was found that the cancer had spread to her lymph nodes.
Blue Cross and Blue Shield of Illinois spokeswoman Maryann Schultz said the company's contralateral prophylactic mastectomy police change went into effect on Aug. 11.
Before the policy change, Severino did not meet the insurer's high-risk criteria for a prophylactic mastectomy, and the procedure in her circumstances was considered "experimental, investigational and/or unproven," Schultz said.
Severino's doctors and surgeons at the DuPage Medical Group and Edward Hospital refused comment on Severino's case.
"The policy was expanded, and (contralateral prophylactic mastectomy) may be considered medically necessary for women who have been diagnosed with breast cancer in the opposite breast," Schultz said.
The policy's previous iteration required things like genetic testing and a family history of cancer in order for the company to approve a prophylactic mastectomy like Severino's, according to Schultz.
Such coverage policy reviews are conducted monthly, with the topics scheduled months in advance, Schultz said.
Blue Cross and Blue Shield of Illinois has 495 medical polices, according to Schultz, with 121 of them reviewed and updated in the past three months.
"This member issue wasn't discussed during the policy review and the timing was irrelevant," Schultz said. "They aren't related."
Severino said she was anxious enough about the surgery, but did not want to have only one reconstructed breast.
"Reconstruction does not leave pretty breasts," she said. "But when you have clothes on, you still feel like a woman."
geoffz@tribpub.com
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