If you’re considering breast reconstruction after mastectomy, you’ll find an overwhelming amount of information on the Internet regarding insurance coverage. But be careful what you read, because not all of it is accurate.
You may already know that federal law ensures your right to breast reconstruction. What you may not know is that the law does not guarantee any type of reconstruction performed by any plastic surgeon in any location.
The Women’s Health and Cancer Rights Act (WHCRA) was passed in 1998. For the first time, it required employer and union group health plans that pay for mastectomy (most do) to also cover the cost of breast prostheses and breast reconstruction. The law also applies to individual plans. (Employer group plans are regulated by the federal government; individual plans are governed by each state.) Prior to this law, 84% of plastic surgeons reported having patients who were denied coverage for breast reconstruction. Health insurance carriers often denied breast reconstruction after mastectomy, labeling it as “cosmetic surgery.”
Here’s a summary of what WHCRA does and does not stipulate, and what it means for health insurers and patients:
Visit the Department of Labor’s website (www.dol.gov/ebsa/publications/whcra.html) to access the text of the law and review a set of Q & A.