PRMA Plastic Surgery

Insurance Coverage - Frequently Asked Questions

One of the most common questions among breast cancer patients is, Will my health insurance cover breast reconstruction? In the vast majority of cases the answer is YES.  

While insurance coverage varies on a patient by patient basis, there are some things that are pretty standard. The Women's Health and Cancer Rights Act (WHCRA) mandates insurance to cover breast reconstruction surgery if you have had a mastectomy.  Breast reconstruction after prophylactic (preventive) mastectomy is also usually covered as long as the patient is deemed high risk for breast cancer (significant family history or BRCA gene positive). 

Let Us Take Care Of Everything

Though knowing your breast reconstruction is covered is reassuring, it does not take away the added stress of trying to keep up with deductibles, co-insurance rates, and out of pocket maximums. After numerous office visits, various procedures, and reconstructive surgery, it can be difficult to keep all your bills organized.

The PRMA billing department is staffed with insurance and billing specialists to help ease this process. We have worked successfully for more than 20 years with numerous insurance providers to ensure proper coverage for our patients.  We will submit your claims and follow up as necessary--keeping you fully informed along the way--until your claims have been paid.  We always provide you with a cost estimate before surgery so you will know your financial responsibility up front. Below you will find answers to some of our most frequently asked insurance questions. For more information or if you have further questions, please give our billing department a call at 210-447-7829. 

Financial assistance is available by other entities or third parties in some cases for those in need.  Your local American Cancer Society is a great resource for information on organizations in your area that may be able to help.  For patients in need living in San Antonio, Thrivewell Cancer Foundation may be an option to help offset some financial responsibilities. For more information visit http://thrivewell.org/patient-assistance/. You can find information on travel and accommodation assistance HERE

For more information on your state breast reconstruction laws CLICK HERE.

What is a Deductible?
What is a Co-Pay?
What is Co-Insurance?
What is an Out-of-Pocket Maximum? And, how do I reach that?
What is an Allowable?
What is Balance Billing?
What is a Global Period?
What is an In-Network or Out-of-Network Provider?
What is NOT covered by my Insurance?