BRCA1+ - looking for insurance coverage for implant replacement?

I'm BRCA1+ and had a propholactic bilateral DIEP mastectomy in January 2012. I had revision surgery in June 2012 to include saline implants. I know want to exchange the round 150 saline implants with teardrop silicone implants because I feel like I don't have the fullness on top and I want the more natural feel of silicone implants. The insurance company denied the surgery and said it was cosmetic. Is there something that I can say on the appeal to get this covered by insurance?

Doctor Answers 1


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That is interesting that the insurance company has taken that position. I would say they don't had the ability to do that because you have had a mastectomy and reconstruction. The 1998 Women's Health Rights Act allows women to get reconstruction after mastectomy and covers all other procedures for symmetry. They are in violation of this law. Nothing your having is cosmetic because the definition of cosmetic is to "improve something that is normal". Reconstructive surgery by definition is done after disease has created the need for surgery.Your surgeon and their office should be able to help you with this situation.

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