Federal law protects your right to have breast reconstruction.

The Women’s Health and Cancer Rights Act (WHCRA) is a federal law that requires group health plans or health insurers that cover mastectomy to also cover the cost of breast reconstruction. This means that in the eyes of the law, breast reconstruction is part of treatment and is not considered to be cosmetic surgery.

What it covers

Timing does not forfeit your right to reconstruct. Coverage applies whenever you have reconstruction: immediately at the time of mastectomy or anytime, even years, later. It also applies if you go flat after mastectomy and then later decide to have reconstruction.

Insurers must provide usual and customary coverage consistent with your existing health plan: you pay
the same deductibles and co-payments you would for other plan benefits.

Coverage includes:

• All stages of reconstruction.

• Surgery on the opposite breast to achieve a symmetrical appearance (after a single mastectomy).

• External breast prostheses.

• Treatment of complications, including lymphedema, related to mastectomy or reconstructive surgery.

What it doesn’t do

The WHCRA doesn't require plans to cover mastectomy—although most do. Government plans, church plans, and some self-funded plans are exempt. Some state laws provide additional protections, while Medicare and Medicaid follow their own rules. If a claim is denied, ask your surgeon’s office for help appealing the decision; denials of reconstruction are often overturned because of this law.