OAKLAND (KPIX 5) – One of the world’s most glamorous women, Angelina Jolie, revealed on Tuesday that she had a double mastectomy and reconstruction with implants because she carries a gene mutation that puts her at high risk of developing breast cancer.
Everyone has the so-called BRCA genes, it’s only when there is a problem – or specific mutation on them – that the risk of breast or ovarian cancer increases. And even those cases are not an exact correlation.
“We think that maybe 15% of all women who are diagnosed with breast cancer have a mutation like that,” said Breast Cancer Surgeon Dr. Lisa Bailey of Alta Bates Summit Medical Center in Oakland. “So the vast majority will have breast cancer for some other reason.”
The test that determines if a woman has the genetic mutations linked to heightened breast cancer risk costs close to $4,000. But insurance experts indicate the entire cost should be covered for patients under the terms of the Affordable Care Act, provided they meet certain conditions.
Nancy Kinkaid of the California Dept. of Insurance said that’s because the test for mutations in the BRCA1 and BRCA2 genes is considered “preventive care.” “There should be no-copay and no out-of-pocket cost for that consultation and evaluation,” Kinkaid told KPIX 5.
But that doesn’t mean just anyone can or should go out and get the test. The preventive care clause applies only to “non-grandfathered” insurance plans, which coverage started after March 2010 when the Affordable Care Act was signed into law. The test will also only be covered for patients with a qualifying family history of breast and/or ovarian cancer.
And for those who do test positive for the gene mutation, Kinkad said there’s no need to worry about being denied coverage or skyrocketing insurance rates.
“Genetic testing can not be considered. It is not a rating factor under the Affordable Care Act,” she explained.
Kinkaid said the Affordable Care Act does not address whether the mastectomy itself is covered. And when it comes to disability or life insurance, the law doesn’t reference genetic testing at all.
Kinkaid said Californians who believe they have been unfairly denied coverage for the genetic test that can and should contact the State Department of Insurance’s Consumer Helpline at 1-800-927–HELP or online at: http://www.insurance.ca.gov/contact-us/0200-file-complaint/index.cfm
(Copyright 2013 CBS San Francisco. All rights reserved.)