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Posted December 09, 2014 in Breast Reconstruction

Mastectomy is the surgical removal of all or part of the breast. This surgery can be performed to treat breast cancer or as a preventive measure for women with a very high risk of developing breast cancer in the future. After the breast is removed, many women feel that part of their femininity has been taken from them. Breast reconstruction is performed to restore the breast to a near normal size, shape, and appearance, and this procedure helps erase the breast deformity that may have been a constant reminder of their battle with cancer. After breast reconstruction, women often feel more confident and feminine, but a lot of women are unaware that their insurance plan will likely cover the cost of the reconstruction.

The Women’s Health and Cancer Rights Act (WHCRA)

The Women’s Health and Cancer Rights Act (WHCRA) is a federal law that requires most group insurance plans that provide coverage for breast cancer treatment to also cover the cost of breast reconstruction. This law applies to group health plans, health insurance companies, and HMOs that cover medical and surgical costs for mastectomy. While the mastectomy and reconstruction benefits may have an annual deductible and co-payment, these fees must remain the same percentage your health plan uses for other covered conditions. (For example, if your health insurance covers 80 percent of your hospital and surgery fees for an appendectomy, then it must also cover 80 percent of your breast reconstruction fees.)

Mastectomy benefits under the WHCRA include:

  • Reconstruction of the breast treated with mastectomy
  • Surgery on the other breast to produce a symmetrical appearance
  • Breast prostheses for wearing in the bra before reconstruction
  • Any physical complications that develop at any stage of the mastectomy

Under the WHCRA, plans are prohibited from denying patients eligibility to enroll or continued eligibility to renew their coverage to avoid providing them with these mastectomy benefits. Additionally, insurance issuers are prohibited from providing incentives to physicians for discouraging their patients from looking into breast reconstruction. Providers are also not allowed to penalize doctors for informing mastectomy patients about their breast reconstruction options.

If you are considering breast reconstruction, please call (214) 827-8407 or fill out our online contact form. Dr. David Morales is a board-certified plastic and reconstructive surgeon who can help you choose the right surgical plan to meet your unique needs and goals.