Is an MRI Covered by Insurance for Future Checks on Silicone Implants That I Have Due to Breast Cancer Reconstruction?

Question

I was diagnosed with cancer my right breast, and had a double mastectomy with immediate expander placement. I just had replacement surgery, with silicone implants. I will now need to have follow-up MRI's every 2-3 years to make sure that they are still okay. I know that my insurance was obligated (by law) to pay for the reconstruction/implants because it was breast cancer, are they ALSO obligated by law to cover the follow-up MRI's and subsequent implant replacement(s), if deemed medically necessary?

Jay Calvert, MD, FACS · Answer

As all things insurance related, this is a difficult question to answer. Every policy is different. Every patient is approached in a different manner by their insurance company so the best thing to do is call your policy carrier or look at your benefits online. Always tricky.

Robert Whitfield, MD · Answer

The Womens Health Rights Act of 1998 requires Insurance companies to pay for reconstruction after mastecomy. MRI is an imaging to used to look at soft tissue and bone. The MRI is used to evaluate implants that could be ruptured. Devices that were put in under study protocol get evaluated at certain times frames. The need for evaulation of your chest wall or axilla will be dictated by your breast surgeon, med onc or rad onc doctors.

Tom J. Pousti, MD · Answer

As you can imagine, it is not possible to provide you with specific  information regarding your insurance  company's policies. Generally speaking, however, given your history, any further surgery and/or imaging related to breast cancer reconstruction will likely be a “covered benefit”.

	Again, for more precise information, check with your insurance company directly.

	Best wishes.

Is an MRI Covered by Insurance for Future Checks on Silicone Implants That I Have Due to Breast Cancer Reconstruction?

Answers (3)