I had a partial mastectomy in August. Will insurance cover breast reconstructive surgery even if the diagnosis wasn't cancer?
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Doctor Answers 3
Partial mastectomy and no cancer diagnosis
Thank you for your question. First of all, it is great news that your diagnosis was not cancer. When it comes to reconstructive surgery it usually depends on your insurance carrier. Your PS can submit for insurance approval and see what the outcome is. You can also contact your insurance carrier and let them know that you had a "partial mastectomy". The word mastectomy is important in non cancerous defects. Lumpectomy is not a good word in these cases. Best of luck.
The only way to know is to ask. See a surgeon who is experienced in breast reconstruction and discuss what may need to be done. Your doctor can then submit a predetermination letter to your insurance company (usually with photos) that outlines your situation and the proposed procedures to correct it. That way you will have confirmation in writing of coverage before you proceed. Good luck!
Contact your insurance company
I would contact your insurance to see if the procedure is covered. Most often times insurances will cover all reconstruction post mastectomy due to diagnosis of cancer. If you were not diagnosed with cancer, but there is enough concern of this to have a partial mastectomy it may be covered. If you are BRCA positive or have a family history of this diagnosis it may be covered. Again I would contact your insurance to confirm.
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