Breast reconstruction surgery, including oncoplastic breast reconstruction, is generally covered by health insurance policies, although coverage for specific procedures may vary. We are contracted and in-network with most major insurance providers and can arrange out-of-network benefits when needed as well. Our office staff can help you with any insurance claims you need to submit to obtain coverage for your reconstructive procedure.
Your Right to Reconstruction
Federal law (the Women’s Health and Cancer Rights Act of 1998) requires group health plans, insurance companies, and HMOs that offer mastectomy coverage to provide coverage for breast reconstruction after mastectomy as well. The coverage offered must include reconstruction of the breast removed by mastectomy, along with reconstruction of the other breast if necessary to produce a symmetrical appearance, and the cost of the breast implant or implants used. Insurers also must cover treatment of any physical complications at any stage of the mastectomy.
The law does not mean that you are entitled to breast reconstruction for free following a mastectomy, but it does state that deductibles and coinsurance charged for reconstructive procedures must be consistent with those established for other benefits under the plan or coverage. In addition to the Federal law, many states have laws that provide additional guidelines regarding insurance coverage for breast reconstruction. For instance, some state laws require coverage for minimum hospital stays associated with a mastectomy.
If you have questions about insurance coverage, you are welcome to contact us online or call 949-759-0980 for more information. You may also wish to contact your insurance provider or learn more about whether your state has enacted additional laws regarding breast reconstruction insurance coverage at www.plasticsurgery.org.