Breast reconstruction can be an important step in the healing process for women who have undergone mastectomies following breast cancer. In the past, approximately one-fourth of all women undergoing mastectomies have chosen reconstructive surgery. However, the number of patients choosing reconstruction is increasing.
For women who do decide to have reconstructive surgery, whether insurance covers the procedures is often a concern. In the past, reconstructive breast surgery was considered by health insurance companies to be “cosmetic.” Luckily, state and federal laws now require health insurance coverage for breast reconstruction.
Federal Law Details
In 1998, the Women’s Health and Cancer Rights Act (WHCRA) was signed into federal law to ensure medical and surgical benefits for women seeking breast reconstruction after mastectomy. The law requires health insurance issuers to provide coverage for reconstruction surgery for any breast removed by mastectomy. The reason for the mastectomy does not change the coverage requirement, so women needing mastectomies for any medical reason are protected by this law.
The WHCRA provides for the following:
- Reconstruction of the removed breast
- Surgery for the other breast to make breasts symmetrical
- External prosthesis to be worn before or during reconstruction process
- Complications that might occur during or after the mastectomy
Health plans that provide coverage for mastectomies must also provide coverage for reconstruction surgery. In some cases, reconstructive surgery may also be covered after a preventative mastectomy if there is evidence to categorize the patient as a high risk for cancer. Companies may institute co-payments or deductibles as outlined in individual plans. However, an insurance company may not assess a higher deductible for breast reconstruction than it does for any other type of surgery.
Exceptions
It’s important to contact your health insurance provider directly to make sure you have coverage for your mastectomy and breast reconstruction procedures. Group health plans generally provide coverage, but some, like church plans or government plans, are not required to. Similarly, Medicare covers breast reconstruction, but there are different levels of health coverage. The minimum hospital stay required may also vary by state law.
Additional Protection
In addition to the federal law, there are additional state law protections governing reconstruction surgery after mastectomy. These local laws may offer additional protection to patients beyond what is required by the WHCRA. Some states also place time restrictions on when the reconstruction must take place, so it is important to know the state laws when you contact your insurance company about coverage.
Contact Us Today to Learn More About Health Insurance Plans for Plastic and Reconstructive Surgery
Women interested in breast reconstruction surgery should contact their insurance company prior to the procedure to find out precisely what their coverage includes. We can also verify insurance coverage for patients or discuss financing options to help cover out-of-pocket costs.
To learn more about options for breast reconstruction surgery, contact our staff at Andrews Plastic Surgery at 319-800-6877.
