Breast Reconstruction is Covered by Insurance
Is breast reconstruction covered by insurance?
When diagnosed with breast cancer, the last thing you want to worry about is whether or not your mastectomy and breast reconstruction will be covered by insurance.
Prior to 1998, many patients did have to pay for the cost of surgery out of pocket – particularly if they wanted breast reconstruction to fix the mastectomy defect.
Fortunately with the passing of the Women’s Health and Cancer Rights Act (WHCRA) by Congress in ’98, breast reconstruction is now mandated by Federal Law to be covered by insurance if the cost of mastectomy is covered.
Watch the video for more information on insurance coverage for breast reconstruction from Dr. Oscar Ochoa.
Fortunately with the passing of the Women’s Health and Cancer Rights Act (WHCRA) by Congress in ’98, breast reconstruction is now mandated by Federal Law to be covered by insurance if the cost of mastectomy is covered.
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I had lumpectomy and 33 radiation treatments about 19 years ago on my right breast. One week ago I had modified radical mastectomy on my right breast due to a malignant tumor. Is it possible for me to have breast reconstruction even though I had radiation years ago on that breast. I am 67 years old but I don’t have any significant health issues such as high blood pressure or diabetes. Considering my age aside from the breast cancer I am in pretty good health.
July 20,2020
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Hi Polly, radiation does not prohibit you from having breast reconstruction regardless of how long ago you had it. If you would like more information on breast reconstruction, please contact me at 800.692.5565 or email me at patientadvocate@prmaplasticsurgery.com. I’d love to help! -Brandy
July 20,2020
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I had a parcel mastectomy in 2007. I was told at the time I could only have reconstruction Surgery if I had a double masectomy. Is this true, or am I eligable?
July 20,2020
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This is a great question! After a lumpectomy (or partial mastectomy), you are eligible for reconstruction. There is no requirement of a double mastectomy for insurance to cover reconstruction.
July 20,2020
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in 2009 I had a single mastectomy (right). This year I went to Dallas to have reconstruction surgery but I am not happy with the results at all. I am on Medicare with a supplemental plan. I think that doctor in Dallas just did the minimum. Can I try again to have it done right? This time I would have a mastectomy on the left side and have everything match. Can you help me ?
July 20,2020
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Hey Linda! It really depends on your specific case. It is possible to revise a previous reconstructive surgery, but it could be considered cosmetic by your insurance. You would need to be evaluated by one of our surgeons to see what could be done to correct your concerns. Please feel free to give us a call to schedule a consultation at 800-692-5565. Thanks!
July 20,2020
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I had breast cancer surgery in 2006 in2009 had tram flap surgery and was then it would require another possible 6 or more surgeries. I stopped at that point. I was wondering if it’s possible to finish out the recon. Now without having. To go through that many more. The breast out pretty much there now. It’s just nipple and a tiny bit of breast shaping that needs to be done in both left and right sides. I’m 60 now but want to look a little bit better please.
September 29,2020
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Great question Donna! To best answer your questions we would need to evaluate your individual needs. We would be more than happy to chat with you more via our virtual consultation process. We welcome you to fill out our virtual consultation form at https://prma-enhance.com/schedule-a-consultation/
September 29,2020
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Polly
I had lumpectomy and 33 radiation treatments about 19 years ago on my right breast. One week ago I had modified radical mastectomy on my right breast due to a malignant tumor. Is it possible for me to have breast reconstruction even though I had radiation years ago on that breast. I am 67 years old but I don’t have any significant health issues such as high blood pressure or diabetes. Considering my age aside from the breast cancer I am in pretty good health.
PRMA Plastic Surgery
Hi Polly, radiation does not prohibit you from having breast reconstruction regardless of how long ago you had it. If you would like more information on breast reconstruction, please contact me at 800.692.5565 or email me at patientadvocate@prmaplasticsurgery.com. I’d love to help! -Brandy
Anonymous
I had a parcel mastectomy in 2007. I was told at the time I could only have reconstruction Surgery if I had a double masectomy. Is this true, or am I eligable?
PRMA Plastic Surgery
This is a great question! After a lumpectomy (or partial mastectomy), you are eligible for reconstruction. There is no requirement of a double mastectomy for insurance to cover reconstruction.
Linda
in 2009 I had a single mastectomy (right). This year I went to Dallas to have reconstruction surgery but I am not happy with the results at all. I am on Medicare with a supplemental plan. I think that doctor in Dallas just did the minimum. Can I try again to have it done right? This time I would have a mastectomy on the left side and have everything match. Can you help me ?
PRMA Plastic Surgery
Hey Linda! It really depends on your specific case. It is possible to revise a previous reconstructive surgery, but it could be considered cosmetic by your insurance. You would need to be evaluated by one of our surgeons to see what could be done to correct your concerns. Please feel free to give us a call to schedule a consultation at 800-692-5565. Thanks!
Donna Bowden
I had breast cancer surgery in 2006 in2009 had tram flap surgery and was then it would require another possible 6 or more surgeries. I stopped at that point. I was wondering if it’s possible to finish out the recon. Now without having. To go through that many more. The breast out pretty much there now. It’s just nipple and a tiny bit of breast shaping that needs to be done in both left and right sides. I’m 60 now but want to look a little bit better please.
PRMA Plastic Surgery
Great question Donna! To best answer your questions we would need to evaluate your individual needs. We would be more than happy to chat with you more via our virtual consultation process. We welcome you to fill out our virtual consultation form at https://prma-enhance.com/schedule-a-consultation/
Patti
Hi! I’m getting ready to finish my chemo treatment in April and would like to schedule a double mastectomy with DIEP at the same time. I’m in South Florida and would like to schedule the surgery in May. I will have to have radiation (because of lymph-node involvement) after. I have Cigna, have you worked with Cigna, and what would be my out of pocket cost?
PRMA Plastic Surgery
Thank you for reaching out. We welcome you to schedule a consultation with one of our board-certified plastic surgeons to review your concerns so they may provide you with their surgical recommendations. You’re welcome to complete our virtual consultation form to schedule your appointment here https://prma-enhance.com/schedule-a-consultation/.
We are in network with Cigna, however, we are unable to provide cost estimates until we verify your individual Cigna plan deductible and out-of-pocket information. Please feel free to give our billing department a call for more information at 210-692-1181. Thank you!