Insurance coverage of sensation restoration procedure post-mastectomy under debate

NEW YORK (WABC) — There’s a new procedure to help women who undergo a mastectomy to continue to have feeling in their chests, but Eyewitness News has found not every insurance company will cover it.

The procedure, called nerve grafting, involves using nerve tissue to fill a gap between damaged nerves, thereby restoring feeling and sensation. During a mastectomy, nerves can be severed and some patients can have permanent numbness in their chests.

Nerve grafting is a surgical technique that has been around for years, but was only recently applied during breast reconstruction. Few studies have been done on the effectiveness of the procedure in breast reconstruction following a mastectomy.

“We’re still early in the curve – that is part of the issue,” breast reconstruction surgeon Dr. Tommaso Addona with New York Plastic Surgical Group said.

Addona said women who have nerve grafting during breast reconstruction report higher levels of satisfaction with their reconstruction and a better quality of life.

Addona said studying nerve grafting in breast reconstruction is a top issue right now for surgeons who deal with patients with breast cancer.

“We’re working on options – or opportunities – techniques that better evaluate sensation and responsiveness of a patient after surgery, so that we can kind of narrow those numbers and have a better understanding of what our base line is so we can show the improvement,” he said.

Sarah Morelli reached out to Eyewitness News because her insurance company – Cigna – would 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 39 years old.

“I grew up without my mom and I have two young boys that I don’t want to have to go through that,” she said.

Morelli wants to have a preventative double mastectomy with nerve grafting.

“I would love to be able to hug my children and feel them against me and have sensation in my skin there, even just for safety measures, so I don’t get burned when I lean up against something,” she said.

However, Cigna does not cover nerve grafting for any condition.

“It’s absolutely ridiculous to me that my health care is being determined not by my provider who is medically trained, 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 that our customers have affordable coverage and access to the full range of mastectomy and breast reconstruction procedures, and to quality surgeons 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. At this time, there is not sufficient clinical evidence to confirm the safety and effectiveness of nerve grafting using an allograft for any condition. If a customer and their physician believe s an experimental, investigational or unproven procedure is medically necessary, they can appeal our determination.”

Cigna isn’t the only insurance company that doesn’t cover nerve grafting for breast reconstruction post-mastectomy.

Anthem Blue Cross lists the policy as not medically necessary and states in its policy that more studies are needed.

Aetna does not list the procedure as medically necessary, but includes positive studies about 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.

The Centers for Medicare & Medicaid told us health officials have not issued a determination for 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 ascertain whether the Medicaid program would cover nerve grafting post-mastectomy by contacting their state Medicaid agency.

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