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BCBSMA approves mastectomy coverage amid policy confusion

Who decides which procedures are medically necessary?
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An updated Blue Cross Blue Shield of Massachusetts policy blindsided a patient recently because it would not cover the full cost of her mastectomy, saying removing the breast without cancer was unnecessary, reported the Boston Globe. However, after an inquiry by the Globe, BCBSMA approved coverage for the patient--as well as for six women who had been denied previously. The insurer said it never meant to deny coverage to the women and cited language-related issues in its policies that confused doctors, patients and its own employees who approve claims. After an internal investigation last week, the insurer will tweak its language to avoid confusion. The issue also raises the question of who decides which procedures are medically necessary. Article