Does Health Insurance Cover Breast Reconstruction?

For many women, breast reconstruction is an important step in healing after a mastectomy. Alongside the emotional weight of that journey, you may have questions about cost and insurance coverage. 

Sorting through insurance details is the last thing anyone wants to do while planning breast reconstruction. That’s why it helps to work with an experienced team like ours at The Breast Center in Lone Tree, Colorado. Dr. Christopher G. Williams and Dr. Jeremy Z. Williams are both board-certified and have advanced training in reconstruction. They lead our team of dedicated staff, who will guide you through the insurance side of surgery. 

Federal Law and Insurance Coverage

The Women’s Health and Cancer Rights Act (WHCRA) of 1998 requires most group health plans and insurance providers to cover breast reconstruction if it follows a mastectomy. That includes:

• Surgery on the reconstructed breast
• Surgery on the opposite breast for symmetry
• Breast prostheses
• Treatment of complications

This law applies regardless of whether the mastectomy was done recently or years ago. It’s important to note that this protection typically applies to group and employer-sponsored health plans. If you have a different type of plan, such as an individual policy or a short-term plan, your coverage may vary. 

Understanding Your Plan

Even when a procedure is covered, details like deductibles, copays, and pre-authorization rules still apply. Some insurance companies require documentation of medical necessity or a referral from an oncologist or surgeon.

Our practice has experience advocating for patients in these scenarios, and we are happy to help you sort through these specifics. We work directly with insurance providers to confirm benefits, handle the paperwork, and explain your out-of-pocket costs.

We encourage you to call and speak with a staff member about your individual coverage so you know what to expect before you commit to surgery. 

Talk With a Team Who Understands

Choosing breast reconstruction is a deeply personal decision, and uncertainty about insurance shouldn’t stand in the way of getting the care you need. 

Contact The Breast Center today at 303-706-1100 to discuss your options. Located in Lone Tree, Colorado, we’re here to support you from consultation to recovery.