Even though breast reconstruction is covered under many insurance policies only 33 percent of eligible women with breast cancer undergo reconstruction. The primary reason for this seems to be that patients have not been informed of their coverage options and were not referred to a plastic surgeon for breast reconstruction.
On June 8, 2012 a bi-partisan committee of politicians* introduced legislation to the House of Representatives called The “Breast Cancer Patient Education Act.” The act requires the Secretary of Health and Human Services to plan and implement an education campaign to inform breast cancer patients of the availability and coverage of breast reconstruction, prostheses and other options. Some legislation is already in place to help women with their recovery.
In 1998 a law entitled the “Women’s Health and Cancer Rights Act” (WHCRA) was enacted to offer certain protections for women with breast cancer who undergo mastectomy. This law helps to ensure that women who are covered for their breast cancer treatment are also covered for reconstructive surgery after mastectomy.
Not all insurance plans are covered under the law including certain church and government plans such as Medicare and Medicaid. If you are considering having breast reconstruction after mastectomy you should check with your health plan about coverage for the procedure.
The “Women’s Health and Cancer Rights Act” offers a telephone help service at 866-487-2365. You can also download the WHCRA guidelines by clicking here or visit the American Cancer Society website. The oncology staff at the cancer center or hospital where you are receiving treatment may also be able to help you predict what the coverage will be.
Getting educated about your rights, insurance coverage and financing options is the best way to avoid the financial obstacles that may stand between you and recovery.
“The Breast Cancer Patient Education Act” will get the best information in the hands of women and their families to empower them in making the best choice for their care,” said ASPS President Malcolm Z. Roth, MD. “Knowledge is power. Federal law has long required coverage for reconstruction and prostheses and no woman should be denied the right to choose the care they need just because they were not aware of their choices.”
If you have questions about breast reconstruction and insurance coverage contact Leif Rogers, MD. We would be happy to assist you.
*H.R. 5937, the “Breast Cancer Patient Education Act.” This bi-partisan legislation was introduced June 8, 2012 in the House of Representatives by Reps. Leonard Lance (R-NJ), Donna Christensen, M.D. (D-VI), Ileana Ros-Lehtinen (R-FL), Marsha Blackburn (R-TN), Gerald Connolly (D-VA), James Moran (D-VA), Hansen Clarke (D-MI), John Lewis (D-GA), Barbara Lee (D-CA), Eleanor Holmes Norton (D-DC), Gwen Moore (D-WI), Charles Rangel (D-NY) and Michael Honda (D-CA).