Will my insurance cover my reconstruction??
This is a very important question for many women facing mastectomy. The Women’s Health and Cancer Rights Act (WHCRA) of 1998 is a federal mandate with protections for women who will have mastectomy because of a cancer diagnosis or other medical reasons. The WHCRA declares that if a group health plan covers a mastectomy, the plan must also provide reconstructive surgery and other post-mastectomy benefits for the patient, including procedures for the opposite (non-cancerous) breast to restore symmetry.
“Under WHCRA, group health plans, insurance companies and health maintenance organizations (HMOs) offering mastectomy coverage also must provide coverage for certain services relating to the mastectomy in a manner determined in consultation with your attending physician and you. This required coverage includes all stages of reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses and treatment of physical complications of the mastectomy, including lymphedema. “ (taken from U.S. Dept of Labor website)
The WHCRA is a complicated federal law and insurance plan requirements vary by state. A health plan should consider the patient's reconstruction of choice to be a covered benefit when the insurance covers mastectomy. Deductibles, co-payments and co-insurance requirements for reconstructive surgery must be consistent with other benefits offered in the health plan. Each patient should be sure to find out what their out-of-pocket costs will be after insurance coverage for reconstruction surgery is verified.
It is also a must for each patient to find out if their particular health plan is subject to this federal law. Find out more information by calling your health plan directly, your State Insurance Commissioner’s office or the US Department of Labor at their toll free number: 1- 866-487-2365.
Your reconstructive surgeon's office should be very experienced in billing health insurance for all stages of reconstructive surgery. Not only do you want a surgeon who routinely performs the reconstruction surgery of your choice, but also has exceptional office personnel and experience in billing insurance for these procedures.