Health Insurance & Breast Implants

Does health insurance cover breast reconstruction surgery?

Ideally, choosing whether or not to have breast reconstruction surgery should depend only upon your personal preferences. However, we understand financial factors may also come into play when making your decision.

The Federal Women’s Health and Cancer Rights Act

In many cases the Federal Women’s Health and Cancer Rights Act (WHCRA) of 1998 obligates insurance companies to cover the cost of breast reconstruction surgery for subscribers who have had a mastectomy. This coverage often extends to procedures performed on the uninvolved breast to restore symmetry, including nipple reconstruction.

What if I don’t have insurance?

If you do not subscribe to an insurance plan, you can explore other options to help defray the cost of reconstructive surgery. Several nonprofit cancer organizations offer financial assistance to patients in need. Additionally, there may be university medical centers or local doctors that have programs offering reconstruction services at more reasonable rates. Talk to your diagnosing physician to find out if he or she is aware of assistance for breast cancer patients in your area.

What should I be aware of when contacting my health insurance provider?

In accordance with the Women’s Health and Cancer Rights Act of 1998, private insurance that covers medically necessary mastectomies will also cover breast reconstruction surgery—including surgery on the uninvolved breast to improve symmetry. Depending on your policy, insurance coverage for procedures and surgeon visits that come after your reconstruction may or may not be covered.

Because coverage policies vary and can change over time, we cannot give any guidance with respect to coverage under any particular health plan. We recommend that you contact your health plan provider to obtain specific information regarding your coverage policies before deciding to proceed with breast reconstruction surgery.

When you interact with any representative of your health insurance agency, be sure to keep a record of your conversations and always retain copies of any written communications. This may help with concerns or coverage discrepancies that may arise in the future.

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