Does Insurance Cover Breast Reconstruction?

irvine plastic surgery

Breast reconstruction patients I see at my Irvine plastic surgery practice often wonder how they will pay for their surgeries. Federal law actually requires insurance companies to cover reconstructive surgery after mastectomy, as well as any procedures on the unaffected breast for the purpose of symmetry. Knowing what is generally covered by insurance can alleviate some of the stress associated with preparing yourself for reconstructive surgery.

Each health insurance policy is different, and rules vary from state to state, but the Women’s Health and Cancer Rights Act of 1998 (WHCRA) established a set of protections for women who elect breast reconstruction after a mastectomy. Basically, if your insurance plan covers the mastectomy, then it has to cover reconstructive surgery and any benefits related to the mastectomy. Some of these benefits include: making the other breast symmetrical, covering the cost of implants used in reconstruction, and paying for care necessary for any complications.

Contending with breast cancer while preparing for a mastectomy is an overwhelming experience for many women. Navigating your insurance coverage should not get in the way of your care when the time comes to move forward with breast reconstruction. Your doctor should have staff members available to help you with insurance questions and paperwork, so that you can concentrate on more important things.

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