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Will disease-specific insurance cover a mastectomy?

Dr. Michael Roizen, MD
Internal Medicine
Not likely. Disease-specific insurance doesn’t directly cover medical costs such as those for a mastectomy. These policies usually pay you a lump sum of cash that you can use for any purpose (typically to help pay for expenses not covered by your general health insurance). But remember, some call these legal robbery policies, because the restrictions are often so encompassing that you are more likely to be hit by lightening twice in a day than benefit from one.

Each insurance policy is different and you must look at the details of your policy to determine if a disease specific insurance policy covers breast cancer and all accompanying treatments. If, for example, your primary policy covers a mastectomy, it must also cover the costs related to reconstructive surgery. According to WHCRA, the Women's Health & Cancer Rights Act of 1998, insurance companies, HMOs, and group health plans must cover services related to a mastectomy if they cover mastectomies. Disease specific insurance policies, because they are supplemental, do not fall under these guidelines, but you may not need it if you have a good primary policy.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.