The Surest guide to breast cancer.

There is so much to think about with a cancer diagnosis—the last thing you should have to worry about is insurance. The Surest health plan offers comprehensive cancer care coverage and resources to help you with your journey. Our Clinical Advocacy team is also available to help you:

• Understand important decisions about your treatments
• Identify quality in-network doctors and facilities
• Share your preferences for care with doctors and other specialists on your care team
• Navigate your Surest benefits to help understand costs for services
• Learn about resources and support groups with other people going through a similar challenge

Request a call from a Surest clinical advocate

What types of doctors treat breast cancer patients?

Your care team may include several types of doctors and clinical professionals:

• Oncologists specialize in the diagnosis and treatment of cancer
• Radiation oncologists specialize in using radiation therapy to treat cancer
• Oncologic/Breast surgeons are specially trained in cancer surgery
• Plastic surgeons specialize in surgery following the removal of cancer, such as breast reconstruction surgery after breast removal (mastectomy)

The Surest app is designed to let you choose doctors and specialists from the large, national UnitedHealthcare network. Search by type of doctor or specialist to view copay options (not estimates) for the visit and to see what’s included in the price. Copays (Prices) for providers and locations are based on a number of factors like quality, efficiency, and effectiveness of care. When providers or locations are evaluated as high value, Surest assigns them a lower copay. Once you decide where to go for care, share this information with your referring doctor to plan next steps.

Can I get help making decisions about my breast cancer treatments?

With a growing number of cancer treatments available, it’s common to feel uncertain about your treatment plan or path ahead. The Surest Clinical Advocacy team is available to help you navigate important decisions.

Clinical advocates can help you find other doctors who specialize in your diagnosis to get a second opinion. Don’t worry about offending your doctor by exploring a second opinion. You are taking an active role in learning more about your condition. Most doctors expect and encourage second opinions.

Contact the Surest Clinical Advocacy team for guidance on getting a second opinion

What types of tests might I need for breast cancer?

Testing helps diagnose and stage cancer, which can help inform treatment plan options. Testing may include lab, biopsy, and imaging:

Laboratory tests

The copay for most laboratory tests can be found by searching for the name of the test in the Surest app. If you can’t find a specific test, call Surest at the number on your member ID card for assistance.

In some cases, your doctor may order genetic tests such as BReast CAncer (BRCA1 and BRCA2). These tests can inform treatments and help assess your future risk of other types of cancer. Genetic testing may need an authorization before the test is done; your doctor will initiate this process. If approved, an in-network BRCA test is a $0 copay.

Biopsy

A biopsy removes a small sample of breast tissue for laboratory testing. A biopsy can be done in different ways, including:

• Fine needle aspiration (FNA)
• Core needle biopsy (ultrasound guided, MRI guided, stereotactic mammography guided)
• Surgical biopsy (lumpectomy, lymph node biopsy)

The copay for a biopsy depends on the type (of biopsy) and where it is performed. Search for the type of biopsy in the Surest app and then compare copays among providers and/or locations.

Your doctor may order gene expression tests (HER2, estrogen receptors, progesterone receptors) on the cancer cells after the biopsy or surgery. Results from these tests help inform the treatment plan. These are typically a $0 copay when done in-network.

Imaging tests

Imaging tests are used to look for cancer, find out how far it has spread, and to see if treatment is working. Some types include:

• CT scan
• MRI
• PET scan
• Bone scan

The price for an in-network X-ray, mammogram, or ultrasound is a $0 copay. If the testing is done as part of a doctor visit, then an office visit copay would apply.

The price for other imaging tests will vary based on where the service is performed. Search the Surest app by the test name to compare options and choose a location. Talk with your provider about where you’d like to have your imaging done and ensure results are sent to your doctor.

What are common breast cancer treatments?

Cancer treatment may include one or several different options, including:

Surgery

Surgery is used to prevent, diagnose, stage, and treat cancer. Surgery can also relieve discomfort or problems related to cancer. Some types of surgery include:

• Lumpectomy—the cancerous part of the breast tissue and some normal tissue around it is removed. Also known as breast-conserving surgery or wide local excision.
• Mastectomy—all the breast tissue is removed. Underarm lymph nodes (modified radical mastectomy) and chest wall (radical mastectomy) may also be removed.
• Breast reconstruction—restores the appearance of a breast after a mastectomy or other breast-related surgery.

Decision aid:

• Should I have breast-conserving surgery or a mastectomy?
• Should I have breast reconstruction after a mastectomy?

Search the Surest app for the type of surgery you need to see copays for various locations. Talk with your doctor about your location choice. The copay will include costs for surgery, anesthesia, and facility use. Surest bundles certain health services that often occur together and prices them accordingly in a single copay, not an estimate, so you know what’s included in the visit before your appointment.

After a mastectomy, your doctor may recommend special post-surgical garments like arm compression garments. Search the Surest app for “arm compression garment” or other types of durable medical equipment and supplies to see your copay or call Member Services for assistance.

Radiation treatment

Search the Surest app for the specific type of radiation therapy you may need. A copay is applied to each session and the amount is shown in the Surest app or website. Some types of radiation therapy may need authorization, and your doctor will initiate this process. Types of radiation may include:

• Conventional External Beam Radiation Therapy (EBRT)—a treatment that delivers a high-energy beam of radiation into the body to target a tumor
• Brachytherapy—a type of radiation therapy that involves placing radioactive material inside the body to treat cancer

Drug treatment

Drug treatments can include chemotherapy, hormone therapy, immunotherapy, or targeted therapy. These medicines may be used alone or in combination and can be given by infusion, injection, applied to the skin, or taken by mouth. The medicine may need authorization so your doctor will need to initiate this process.

• Injections and infusions can be given in the office or in an outpatient setting. Search the name of the drug in the Surest app to view your copay at different locations; a copay is applied per session.
• Chemotherapy given by mouth or applied to the skin is typically covered by your pharmacy benefit. Search the name of the drug for coverage information. If you see a link to a pharmacy page, click there to view your coverage for the drug.

Your doctor may recommend an implanted port or central venous line for the delivery of chemotherapy and other medicines. If the port is inserted during the same day as another surgery you are having, it will be included in the copay for the surgery. If the port is inserted as a separate procedure on another day, your copay will depend on the location. Search the Surest app for copay information.

Decision aid:
Should I have chemotherapy for early stage breast cancer?

What other services might help during breast cancer?

It’s important to talk with your doctor about all of your symptoms, treatments, expectations, and what is important to you. Depending on your need, additional support options may be available such as:

Dietitian

A dietitian visit can be helpful if you have problems related to food and digestion. Search “dietitian” in the Surest app for cost and coverage information.

Home health care

Home health visits are provided in the home and offer a variety of services such as wound care, education, IV and nutrition therapy, and monitoring of health status. Coverage requires a doctor to order home health care services. Visit limits may apply.

Find the copay for a home care visit in the Surest app by searching “home health service.” Talk with your doctor to see if home health care is right for you.

Acupuncture

A visit for acupuncture therapy involves the insertion of thin needles into the skin to treat injuries, diseases, and deformities. This can help control symptoms such as pain, fatigue, nausea or vomiting. Your copay for an acupuncture visit can be found by searching “acupuncture” in the Surest app. Visit limits may apply.

Palliative care

Palliative care can improve quality of life if you have a serious or life-threatening disease such as cancer. You may receive palliative care along with treatment for cancer. The palliative care team addresses symptoms and side effects of the disease and treatment, and supports your psychological, social, and spiritual needs. To view your coverage for palliative care, search “palliative care” in the Surest app. Palliative care does not include respite care or hospice services.

Support for stress, anxiety and uncertainty

A breast cancer diagnosis often affects the emotional health of patients, families, and caregivers. You can find coverage for in-person and virtual mental health care in the Surest app. Search “mental health” to find providers, treatment options, and copays.

The Surest Clinical Advocacy team is also available to offer support and guidance for navigating care and coverage. Reach out if you need help

Additional resources you may find helpful:

Cancer.org,CancerCare.org,Breastcancer.org

To find care, Surest members can see options and prices available using the Surest app or website.

Search now

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This content is not medical advice. You should always consult with your health care professional.

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