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I found my insurance is not a ppo so the reconstruction surgery is not covered so now instead of 2 months it will be 4 to 7 months be be for any surgery at all . I love that every where you read that this is cover by insurance then it like a game there is some much not cover for breast cancer double mastectomy. I guess I just pissy to go through all the scans and biopsy have everything ready to go November 21 and now all on hold again. I have to change insurance company before we can move… read more
You tell your insurance company they have to pay for it by law
I wouldn't put off your breast surgery for 7 months because of the reconstruction issue. Breast cancer left in the spread can grow and spread. Follow the advice @A MyBCTeam Member gave you. She seems to know a lot about this.
The AI response is correct in stating insurance companies have to cover your reconstruction surgery after they have covered your breast cancer surgery. And it's not just during the immediate reconstruction phase either. If you have some sort of problem with implants (if you go that route) they have to cover your additional reconstruction costs to remove and replace them or whatever is required to deal with the situation. When it comes time to change the implants since that's supposed to be done every ten years or so the insurance company is required to pay for that too. I copied the below from CMS.gov and there is a link below.
"The Women's Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protections to patients who choose to have breast reconstruction in connection with a mastectomy.
If WHCRA applies to you and you are receiving benefits in connection with a mastectomy and you elect breast reconstruction, coverage must be provided for:
All stages of reconstruction of the breast on which the mastectomy has been performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
Prostheses and treatment of physical complications of all stages of the mastectomy, including lymphedema.
This law applies to two different types of coverage:
Group health plans (provided by an employer or union);
Individual health insurance policies (not based on employment)."
https://www.cms.gov/cciio/programs-and-initiati...
Insurance companies that cover mastectomies are legally required to cover breast reconstruction surgery after mastectomy in the United States. If your insurance has denied coverage, this may be worth appealing since it should be covered by law.
Here are some financial assistance options to explore
• Contact the hospital's Show Full Answer
Breast reconstruction and health insurance
Contact your insurer to find out the specifics of coverage under your plan. In the United States, a federal law called the Women's Health and Cancer Rights Act (WHCRA) of 1998 requires group health insurance plans that pay for mastectomy to also cover breast reconstruction. https://www.dol.gov/agencies/ebsa/about-ebsa/ou...
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