Chance of State Insurance Covering Reconstruction After Masectomy?

I had a partial masectomy from a large lump that was in my breast. I did not need any further treatment afterward. It was diagnosed as an infected cyst instead of a suspected phyllodes tumor that runs in my family. I have state insurance which covered the masectomy but do I have good chance to get coverage for the reconstruction? I was already approved for a consultation, but not sure if I can get my hopes up. My right breast has is less than 1/4 the size of the left and I have no feeling

Doctor Answers 4

Insurance Covers Post Mastectomy Reconstruction

Your description would certainly fall under the category of breast reconstruction. Therefore I think you have a high likelihood that your State Insurance would cover your partial mastectomy reconstruction.

Orange County Plastic Surgeon
4.9 out of 5 stars 159 reviews

Mastectomy Reconstruction Should be Covered

Based on a 1998 Federal law that mandates post-mastectomy breast reconstruction insurance coverage, your reconstruction should be covered by your insurance.   Best of luck.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 211 reviews

Lumpectomy defect treatment coverage depends on your policy

You'll need to review your carrier's policy manual on this. The federal legislation that mandates coverage of breast reconstruction, the WHCRA Act, does not include partial mastectomy in it's language. Different insurers have different positions on whether you would be considered covered for this.

Robert Oliver Jr., MD
Birmingham Plastic Surgeon
5.0 out of 5 stars 3 reviews

Coverage for breast reconstruction

There is no real way to give you an accurate answer to this question as it will vary from state to state.  Continue with the consultation process and in this way you will get an answer as to coverage for breast reconstruction.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

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.