Does health insurance cover breast cancer reconstruction?


Yes, it does.

Under the Women's Health and Cancer Rights Act of 1997, insurance companies are required to cover breast reconstruction following a mastectomy, radiation, lumpectomy and any other breast cancer treatment.

The breast reconstruction will cover:

  • Reconstruction of the breast that underwent breast cancer treatment
  • Surgery to make sure that the reconstructed breast matches or is symmetrical to the natural breast (this can include surgery of the natural breast)
  • Treatment of any complications arising from the reconstructive surgery, including lymphedema
  • Prosthesis necessary for the reconstruction

This will ensure that:

  • All the stages of the process of breast reconstruction are completed.
  • The two breasts are symmetrical in appearance.

Insurance companies are required to inform you of this coverage when you enroll in a plan.

But even if this is the case, you must check with your health insurance company before you go for breast reconstruction. The doctor and the patient will have to be in agreement as to the necessity of the breast reconstruction, otherwise, it may not also be payable under the insurance.

Also, the limits specified in the policy will apply. This means that purely cosmetic and elective surgery will not be payable - this includes procedures such as nipple tattooing.

The healthcare reform bill has also provided additional benefits to those who want to prevent or may have suffered (and survived) breast cancer:

  • Additional screening tests (like mammograms) will be covered for women starting age 40. Early screening will help increase the chances of a woman surviving breast cancer. The US Preventive Services Task Force has already recommended that mammograms be given for women starting age 50 and not earlier. However, this guideline is not followed due to revisions made on the healthcare reform bill. It requires health insurance companies to cover mammograms even for women ages 40 to 49, for as long as their doctor requires this.
  • Insurance companies can no longer deny you coverage while citing breast cancer as a pre-existing condition.
  • Additional services for wellness.
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