Is Breast Reconstruction Surgery Covered by Insurance?
A common question among breast cancer patients is whether their medical insurance plan will cover the costs of breast reconstruction cosmetic surgery. While the answer is ‘yes’ in many cases, patients should discuss the insurance aspects with their surgeon as well as the insurance provider.
Terrific, pragmatic, and board certified female plastic surgeon Dr. Farah Naz Khan provides breast reconstruction to patients in Dallas, Texas and other towns and suburbs in this region of the sterling state of Texas.
Key Facts about Breast Reconstruction Insurance
Although insurance coverage will vary from case to case, some aspects in breast reconstruction cosmetic surgery insurance are fairly standard. According to the Women’s Health and Cancer Rights Act (WHCRA) mandate, insurance policies must cover breast reconstruction surgery if the patient has had a mastectomy.
If breast reconstruction is performed following a preventive mastectomy, the patient will still be covered in most cases, provided she is deemed a high risk candidate for breast cancer. As per the Women’s Health and Cancer Rights Act of 1998, every group health plan that pays for mastectomy must also pay for reconstructive surgery and prostheses.
Furthermore, Medicare too covers breast reconstruction, but Medicaid coverage can differ between states.
Check Insurance Aspects in Advance
Even when a patient is covered by insurance for breast reconstruction, it is still possible to run into problems in certain situations.
For instance, if the patient has selected a newer reconstructive technique, is undergoing the surgery to create a more balanced appearance, or requires revision of a previous reconstruction, coverage issues could arise. Another concern could be if the patient wants to select a plastic surgeon who is not within her health insurance plan’s network.
The patient should check with her insurance provider upfront and find out precisely what is covered so that she can make her choices accordingly. The surgeon’s office may also be able to offer guidance about insurance claims. Patients could also check with the health insurance agency and commissioner in their state to know the rules governing coverage for breast reconstruction.
Questions to Ask
The following questions may be used as a guide during the patient’s discussions with the insurer and the surgeon’s office pertaining to breast reconstruction insurance:
- Does my insurance plan cover mastectomy (which will automatically cover reconstruction)?
- How can I obtain pre-authorization for my breast reconstruction surgery?
- Does my plan limit my choices to in-network surgeons and services?
- If I choose a surgeon who is not within my network, what costs would still be covered?
- What will be my out of pocket costs if I choose a surgeon who is not within my network?
- Does my plan cover hospital stay, and if yes, for how many days?
- Does my plan cover other healthcare providers involved in my procedure?
- Will all bills be paid directly to providers?
The patient should be aware that she will still have the responsibility to pay for deductibles and co-pays, and should have a clear idea of how much she will be required to pay out of pocket. Astute, proven, and board certified female plastic surgeon Dr. Farah Naz Khan receives patients from Dallas, Texas and other neighborhoods and communities in this section of the nation for breast reconstruction surgery.