Reconstruction after Lumpectomy and insurance coverage.

Question

I had lumpectomy on both breast about 14 years ago, both benign. I just had a lumpectomy again yesterday to remove a radial scar on my left breast, still waiting on pathology results. If it turns out to be benign, is the insurance still required to cover breast reconstruction after Lumpectomy under the Womens Health and Cancer Rights Act or does that law only apply if you have cancer/mastectomy? Thanks in advance!

Finny George, MD · Answer

Hi, thank you for sharing your question. Benign pathology that can deform the breast or create asymmetry will also be covered by insurance. This is a question that you can ask your specific insurance carrier. Symmetrizing breast procedures are covered and performed for varying conditions.

Ryan Rebowe, MD · Answer

Unfortunately based on that well cited law insurance is not absolutely obligated to pay for your reconstruction following a lumpectomy. However, most insurance companies are now covering lumpectomy defects following cancer excision and radiation. If the lumps are benign, it is more difficult to get it covered, however based on the popularity of oncoplastic procedures covering this sort of thing has been more commonplace. I would recommend visiting a board certified plastic surgeon who does a fair amount of breast reconstruction as they and their staff will best know the process.

Heather Pena, MD - Account Suspended · Answer

Yamilette-
Coverage under the Women's Health and Cancer Rights Act typically only requires coverage for cancer reconstruction. You can always have your provider submit a prior authorization for the planned reconstruction, and sometimes these can be covered, but it is not required.
Best of luck!

BREAST RECONSTRUCTION PROVIDERS NEAR YOU

Reconstruction after Lumpectomy and insurance coverage.

Answers (3)

BREAST RECONSTRUCTION PROVIDERS NEAR YOU