Does Insurance Cover Breast Reconstruction for Cancer Patients?

Many breast cancer patients are not aware that breast reconstruction is a viable option–both financially and physically–after a mastectomy.

Since 1998, the Women’s Health and Cancer Rights Act (WHCRA) has helped women with breast cancer who wish to have breast reconstruction surgery following a mastectomy. The WHCRA mandates that insurance companies that offer mastectomy coverage must also cover:

• Reconstruction of the breast(s) on which the mastectomy was performed,
• Reconstruction of the other breast to produce a symmetrical appearance (if only one breast underwent a mastectomy), and
• The actual breast implant(s) used in the reconstruction of the breast.

WHCRA applies to group health plans for plan years starting on or after October 1, 1998, when the WHCRA was passed. However, the WHCRA is a complex law. It does not apply to Medicare and Medicaid, and several states have their own laws surrounding health plans and mandated coverage for mastectomies and reconstructive surgery. It is recommended that you contact your insurance company, your state’s insurance department and/or the US Department of Labor for more information.

If you are considering post-cancer breast reconstruction, contact Dr. Ali to discuss your options and learn more. Dr. Ali is highly recommended by oncologists and frequently gets involved with patients pre-mastectomy so that the reconstruction can be planned for.

For more information, download Dr. Ali’s free white paper, Introduction to Breast Reconstruction: Understanding Your Options.