Is a Breast Revision for Reconstruction After a Matectomy Normally Covered by Insurance?

I was wondering if a revision surgery for breast reconstruction after a mastectomy is normally covered by insurance? Are there certain things that would make coverage more or less likely? I am no longer with the same carrier who covered the mastectomy and reconstruction, however I do have coverage for preexisting conditions. Thank you for any help you can provide here.

Doctor Answers (3)

In New York State, coverage of breast reconstruction for breast cancer is mandated, and

+2

coverage includes necessary revisions of the reconstruction, and surgery on the opposite (non-cancerous) breast for symmetry.  Following mastectomy, reconstruction with either an implant or your own tissues are covered by both government and private carriers.  If a revision is necessary, your surgeon should send the necessary documentation to your insurance carrier and obtain pre-certification of coverage of the revision.  


White Plains Plastic Surgeon
5.0 out of 5 stars 1 review

Women's Rights for Breast Reconstruction Following Mastectomy

+1

The simple answer is yes, you should be covered for required revisionism post mastectomy reconstruction  Basically,  The Federal Women's Health and Cancer Rights Act of 1998 is still the law today

Under the federal Women's Health and Cancer Rights Act of 1998, a yearly notification
of your benefits pertaining to breast reconstruction must be sent to you by your insurance company.
The Women's Health Care Act states that benefits must be provided for:
Reconstruction of a surgically removed breast
Surgery and reconstrcution of the other breast to produce a symmetrical appearance
Prostheses and treatment for physical complications from all stages of a mastectomy, including lymphedema

These benefits are subject to the conditions and terms of your plan, including maximum benefit amounts, deductibles,
copayments, and coinsurance provisions. The benefits are subject to your plan's exclusions and limitations.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 51 reviews

Breast Reconstruction

+1

 Insurance carriers are so variable on what they cover, how much they cover, and how long they will cover a given problem that you need to call your carrier and get information in writing on what is covered, and then you can make firm plans on what you want to do next.

Vivek Bansal, MD
Danville Plastic Surgeon
5.0 out of 5 stars 10 reviews

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.