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avada_faq

Yes and no. Most insurance plans offer some coverage for breast cancer treatment. To the same degree that your insurance covers your mastectomy, it must legally also cover your breast reconstruction. However, not every plan covers every specialist you have to meet with. Make sure you talk to your insurer about what your policy does and does not cover. For anything that is not covered, talk to your hospital to see if you have any options to reduce out-of-pocket costs. We also have a series of articles thathelp our readers understand insurance and breast reconstruction:

Breast Cancer Bill of Rights

In the U.S., the Women’s Health and Cancer Rights Act (WHCRA) states that women, whose insurance covered mastectomy due to cancer, must have insurance coverage for breast reconstruction. This coverage applies to all stages of breast reconstruction. Furthermore, it ensures women have coverage for additional surgeries to improve breast symmetry or treat physical complications. Some states also maintain coverage requirements beyond this.

Medicare offers partial coverage for breast forms and mastectomy camisole and bras. Under Medicare, you can usually get coverage for one silicone breast form every two years or one foam form every six months. Four to six mastectomy bras are covered each year. However, more can be covered if they are prescribed by a physician. Three camis per month are also covered if they are medically necessary.

WHCRA stands for the Women’s Health and Cancer Rights Act. This federal law was

signed in 1998 and protect patients who undergo breast reconstruction in connection with a mastectomy. According to the WHCRA, coverage must be provided for all stages of reconstruction of the breast that was removed during a mastectomy. Coverage for surgery on the other breast to improve symmetry is also required, as is prostheses and the treatment of physical complications.

Have questions we’ve not answered? Let us know.