Breast Reconstruction Surgery

Is breast reconstruction surgery covered by insurance?

A Answers (7)

  • AMichele Manahan, MD, Plastic/reconstructive Surgery, answered on behalf of Johns Hopkins Medicine

    Federal and state laws require insurance companies to pay for all or part of the cost of breast reconstruction at any time after removal a patient's breast tissue. This includes any surgery required on the opposite breast for symmetry.

  • AMark Sisco, MD, Plastic/reconstructive Surgery, answered on behalf of NorthShore University HealthSystem
    Mark Sisco, MD - Does insurance cover breast reconstruction surgery?

    Federal law has mandated that insurance companies cover patients undergoing reconstruction breast cancer surgery or risk reducing breast surgery. Learn more from Dr. Mark Sisco on behalf of NorthShore University about breast reconstruction surgery.

  • ARob E. Ferguson, MD, Plastic/reconstructive Surgery, answered on behalf of Intermountain Healthcare

    The Women's Health and Cancer Rights Act (WHCRA) of 1998 does include requirements for insurance companies to cover reconstruction of a breast defect following a mastectomy.  It also provides for reasonable correction of asymmetry.  The caveat, however, is that the act exempts government plans from this requirement (such as Medicare and Medicaid).  My personal experience, however, is that Medicare is quite cooperative in assisting women with reconstruction following mastectomy despite not being legally bound to such.

  • AStuart Linder, MD, Plastic/reconstructive Surgery, answered

    Both federal and state laws require that breast cancer reconstruction be covered by health insurance.  This may include not only the affected breast but the contralateral breast in order to regain a form of symmetry.  In general, breast cancer reconstructions may require multiple stages and each of these stages should be covered by your insurance.  Stages can include tissue expanders, breast implant placement status post expansion, autologous tissue transfer, and nipple-areolar reconstruction.

  • AAjay Sahajpal, MD, Oncology, answered on behalf of Aurora Health Care
    It generally isn't covered for purely cosmetic purposes, unless part of a cancer operation to remove the breast and reconstruct.
  • AHeather Karu, MD, Plastic/reconstructive Surgery, answered on behalf of Sanford Health
    Karu  - Does insurance cover breast reconstruction surgery?

    If breast reconstruction surgery is needed to restore symmetry after a partial or full mastectomy, can you really call the procedure merely cosmetic? In this video, Dr. Heather Karu discusses a patient's legal rights when it comes to reconstructive surgery.

  • AErik Hoy, MD, Plastic/reconstructive Surgery, answered
    Since 1998, Congress has mandated universal insurance coverage for breast reconstruction after removal of breast cancer.  This even includes staged procedures such as the filling of adjustable breast implants or reconstruction of the nipple.  It also covers cases in which a breast lift is required in a normal breast in order to better match a reconstruction on the cancerous breast.  Now, new legislation in New York state will require doctors and healthcare centers to review reconstruction options with patients prior to the resection of their breast cancer.  If the initial center does not perform reconstructions, the patient must be referred to one that does.  These laws help protect a patient's access to reconstructive surgery after breast cancer removal.

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