Breast Reconstruction Insurance: Physician Shares What You Need to Know
13 May 2017
Today we welcome Cristiane Ueno, MD. She shares important, but not widely known, information related to breast reconstruction insurance. Thank you, Docter Ueno!
How much do you know about the “Women’s Health and Care Rights Act (WHCRA)” of 1998?
Federal Law Requires Insurance Companies to Cover Breast Reconstruction
The WHCRA was signed into law on October 21, 1998, and states that group health plans, insurance companies, and health maintenance organizations must provide coverage for reconstruction after mastectomy for breast cancer, including all stages of reconstruction and reconstruction of the other breast for symmetrical appearance, and cover prostheses and treatment of lymphedema.
I started thinking about it on my first week at my job in West Virginia . . . I found out that a patient canceled her appointment with me because I am a plastic surgeon. You may find it odd, but the truth is that this patient underwent a mastectomy and was looking for a “way to feel normal again.” The minute she noticed that she was going to see a plastic surgeon, it struck her that she didn’t have the money.
Fear of Cost Prevents Women from Seeking Reconstructive Surgery After Mastectomy
Unfortunately, this isn’t an isolated story. Later I started to see patients coming after partial and total mastectomies that never heard about reconstructive options: “I was told by my physician that immediate reconstruction was not possible,” “The plastic surgeon where I live doesn’t take my insurance,” “I never heard about reconstruction,” and more recently, “I heard that I can’t have reconstruction because I will need radiation therapy after my mastectomy”.
You may think that those conversations came before the WHCRA, right?
Sadly, they happened in 2014 and continue to happen in 2017. And you may ask why.
- Studies showed that breast reconstruction after mastectomy rose from 31% to 36% between 1998 and 2007.
- An evaluation of the New York State database between 1998 and 2006 found that breast reconstruction increased amongst all women.
However, studies showed other gaps:
- Although breast reconstruction increased, the racial/ ethnic difference between the white and minority remains.
- Patients in near metro and rural areas are less likely to receive breast reconstruction probably due to lack of plastic surgeons in rural communities, difficulty with traveling and lower likelihood of providers referring patients for reconstruction.
Health and Human Services Is Working to Educate Patients
In 2016 with the support of “The American Society of Plastic Surgeons”, Congress passed the Breast Cancer Patient Education Act (BCPEA) that requires the Secretary of Health and Human Services to assist with the expansion of an educational campaign to educate patients about the availability of breast reconstruction and available alternatives.
Reading the reconstruction stories on this blog, I found Karen’s and she cleverly states: “knowledge is power.” We should “take charge” of our lives and you may even say destiny by being proactive and looking for choices.
For that reason, we are embarking on this journey together. With the help of “I’m Taking Charge,” we will continue not only our personal journeys, but also the journey to support other women that are looking for breast reconstruction: not for vanity, but to feel normal, to feel that they belong to society.
Find more about breast reconstructive options at the American Society of Plastic Surgeons website.
References used for this article:
- Iskandar ME, Dayan E, Lucido D, Samson W, Sultan M, Dayan JH, et al. Factors influencing incidence and type of postmastectomy breast reconstruction in an urban multidisciplinary cancer center. Plast Reconstr Surg. 2015; 135: 270e.
- Yang RL, Newman AS, Reinke CE, Lin IC, Karakousis GC, Czernieck BJ, et al. Racial disparities in immediate breast reconstruction after mastectomy: impact of State and Federal health policy changes. Ann Surg Oncol. 2013; 20: 399-406.
- Yang RL, Newman AS, Lin IC, Reinke CE, Karakousis GC, Czerniecki BJ, et al. Trends in immediate breast reconstruction across insurance groups after enactment of breast cancer legislation. Cancer. 2013; 119: 2462-2468.
- Xie Y, Tang Y, Wehby GL. Federal health coverage mandates and health care utilization: the case of the Women’s Health and Cancer Rights Act and use of breast reconstruction surgery. J Women’s Health. 2015; 24: 655- 662.
- Tseng WH, Stevenson TR, Canter RJ, Chen SL, Khatri VP, Bold RJ, et al. Sacramento area breast cancer epidemiology study: use of post mastectomy breast reconstruction along the rural-to-urban continuum. Plast Reconstr Surg. 2010; 126: 1815-1824
- Essig, R,Ueno, CM. Perception of healthcare providers regarding breast reconstruction “Women’s Health and cancer Rights Act” (1998) through evaluation of continuing medical education conference. 2016 Clinics in Surgery; volume1, article 1180.