Insurance Coverage for Breast Reconstruction

April 9, 2014


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shutterstock_138113543

Breast reconstruction can be an important step in the healing process for women who have undergone mastectomies. Unfortunately, studies have shown the percentage of women opting for reconstruction surgery has been traditionally low. In the past, approximately one-fourth of all women undergoing mastectomies have chosen reconstructive surgery. Fortunately, the number of patient’s choosing reconstruction is increasing.

For women that do make the decision to have reconstructive surgery, whether insurance covers the procedures is often a concern. In the past, reconstructive breast surgery was considered by insurance coverage to be “cosmetic.” Luckily, state and federal laws now require insurance companies to cover the costs of breast reconstruction.

Federal Law Details
In 1998, the Women’s Health and Cancer Rights Act (WHCRA) was signed into federal law to ensure insurance coverage for women seeking breast reconstruction after a mastectomy. The law requires health plans to provide coverage for reconstruction surgery for any breast removed by mastectomy.  The reason for the mastectomy does not change the coverage requirement, so women needing mastectomies for any medical reason are protected by this law.

The WHCRA provides for the following:

  • Reconstruction of the removed breast
  • Surgery for the other breast to make breasts symmetrical
  • External prosthesis to be worn before or during reconstruction process
  • Complications that might occur during or after the mastectomy

Insurance companies that provide coverage for mastectomies must also provide coverage for reconstruction surgery. In some cases, reconstructive surgery may also be covered after a preventative mastectomy, if there is evidence to categorize the patient as a high risk for cancer. Companies may institute co-payments or deductibles as outlined in individual plans. However, an insurance company may not assess a higher deductible for breast reconstruction than it does for any other type of surgery.

Additional Protection
In addition to the federal law, some states have their own laws governing reconstruction surgery after mastectomy. These local laws may offer additional protection to patients beyond what is required by the WHCRA. Some states also place time restrictions on when the reconstruction must take place, so it is important to know the state laws when you contact your insurance company about coverage.

Women interested in breast reconstruction surgery should contact their insurance company prior to the procedure to find out precisely what their coverage includes. Surgeons can also verify insurance coverage for patients. To learn more about options in breast reconstruction surgery, contact our staff at Physicians’ Clinic of Iowa, Plastic Surgery at 319-382-8230.

June 26th, 2013

Dr. Andrews is an artist. His academic credentials are second to none. You can see that sensibility in every aspect of his practice, and his life. His outcomes are exceptional, and there isn’t a surgeon anywhere that I trust more.*
2015-02-10T19:25:22+00:00
Dr. Andrews is an artist. His academic credentials are second to none. You can see that sensibility in every aspect of his practice, and his life. His outcomes are exceptional, and there isn’t a surgeon anywhere that I trust more.*

May 27th, 2013

I am beyond happy with my results. I had extra skin hanging from my abdomen after gaining weight from pregnancies. Dr. Andrews was compassionate and understanding about how this affected me and my self-esteem.*
2015-02-10T19:25:46+00:00
I am beyond happy with my results. I had extra skin hanging from my abdomen after gaining weight from pregnancies. Dr. Andrews was compassionate and understanding about how this affected me and my self-esteem.*

May 27th, 2013

I can now wear bikinis! I continue to work out and can finally see the results of my hard work. Thank you Dr. Andrews – a California gem in the midwest!*
2015-02-10T19:26:11+00:00
I can now wear bikinis! I continue to work out and can finally see the results of my hard work. Thank you Dr. Andrews – a California gem in the midwest!*

June 1st, 2013

Dr. Andrews is one of the best plastic surgeons I’ve worked with! His patients are very pleased with their results. I highly recommend him!*
2015-02-10T19:26:35+00:00
Dr. Andrews is one of the best plastic surgeons I’ve worked with! His patients are very pleased with their results. I highly recommend him!*

Jan 24th, 2013

Dr Andrews was wonderful!! Great Guy… awesome job on my reconstruction!!*
2015-02-10T19:26:55+00:00
Dr Andrews was wonderful!! Great Guy… awesome job on my reconstruction!!*

Nov 2nd, 2012

I had suffered debilitating Hidradenitis. He gave me the ability to have a normal life again. My scars look amazing and he was able to close with the most beautiful lines! He was such a caring doctor who is so gifted. I hope to follow his practice wherever he may go!*
2015-02-10T19:27:28+00:00
I had suffered debilitating Hidradenitis. He gave me the ability to have a normal life again. My scars look amazing and he was able to close with the most beautiful lines! He was such a caring doctor who is so
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Oct 29th, 2012

Dr. Andrews was the absolute best doctor for me - very informative, sensitive, and caring with just the right amount of humor during the appointments.*
2015-02-10T19:27:54+00:00
Dr. Andrews was the absolute best doctor for me – very informative, sensitive, and caring with just the right amount of humor during the appointments.*

Extraordinary doctor

Before saying that you are an extraordinary doctor, I want to tell you that you are an extraordinary human being. Thanks for showing me so much care and concern.*
2015-03-30T12:00:04+00:00
Before saying that you are an extraordinary doctor, I want to tell you that you are an extraordinary human being. Thanks for showing me so much care and concern.*

You Rock!!

I wanted to write you a thank you letter because I would never be able to find the words to say how much I appreciate everything you did for me. Thanks to you I can feel normal and not always worry if people will find out about my problem. I can’t even begin to say thank you enough or to show my gratitude. You’re an amazing person, wonderful doctor, and my hero. All in all, you ROCK!!!*
2015-03-30T12:00:42+00:00
I wanted to write you a thank you letter because I would never be able to find the words to say how much I appreciate everything you did for me. Thanks to you I can feel normal and not always
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You all are the best!

Thank you so much for ALL of your help in my recovery thru “sometimes emotional” journey with my cancer. You all were always professional and took the time with my long list of questions. I can n0t thank you enough! Easter is my favorite time of the year and I pray God will continue to strengthen your gift and skills in healing because you all are the best!*
2015-03-30T12:02:02+00:00
Thank you so much for ALL of your help in my recovery thru “sometimes emotional” journey with my cancer. You all were always professional and took the time with my long list of questions. I can n0t thank you enough!
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Amazing!

I’m ecstatic with my new body. It is PERFECT! I can’t even put in wordshow we feel, You are so compassionate unlike any Doctor I’ve met. I realize I’ve been a needy patient and you handled me well. You’ve gone above and beyond with me after hours for medications and issues. Also more quotes than necessary, but you did it! Your work ad attentiveness to my expectations I can’t say enough!! Now to pu the finale pictures in your gallery to show how complete I am now! You are AMAZING! Thank You! It’s been a very long, hard journey! Now to live life with the new ME!*
2015-03-30T12:02:20+00:00
I’m ecstatic with my new body. It is PERFECT! I can’t even put in wordshow we feel, You are so compassionate unlike any Doctor I’ve met. I realize I’ve been a needy patient and you handled me well. You’ve gone
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With appreciation

With appreciation for putting me back together!*
2015-03-30T12:02:40+00:00
With appreciation for putting me back together!*

I am forever grateful

I consider myself blessed to be under your care as I navigated the stormy sea of breast cancer diagnosis, surgery, reconstruction, and recovery. I cannot thank you enough and am so pleased with the results! You have all been wonderful, and I will miss seeing you even though I am thrilled to be healed and moving on! The impact you have on patients who are scared and overwhelmed cannot be overstated...and I am forever grateful.*
2015-03-30T12:03:02+00:00
I consider myself blessed to be under your care as I navigated the stormy sea of breast cancer diagnosis, surgery, reconstruction, and recovery. I cannot thank you enough and am so pleased with the results! You have all been wonderful,
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Thank You

Thank you. For me, you are as similar as God because you created me again. It’s an amazing feeling. I feel my earlier life back again. Once again thank you very much from the bottom of my heart.*
2015-03-30T12:03:24+00:00
Thank you. For me, you are as similar as God because you created me again. It’s an amazing feeling. I feel my earlier life back again. Once again thank you very much from the bottom of my heart.*

April 12, 2016

Since my hysterectomy, sex has been extremely painful. I suffered from extreme dryness and discomfort. I had no sex drive and was no longer able to experience an orgasm. Until, recently, when a friend told me about Courtney Albritton and PCI's ThermiVa treatment. I have had 2 of the 3 treatments and immediately experienced positive results. I am still in awe of the results I have experienced. The procedure was painless. Until ThermiVa, I had come to the realization that my sex life would no longer be what it once was pre-hysterectomy. I highly recommend this procedure.*
2016-05-05T11:40:35+00:00
Since my hysterectomy, sex has been extremely painful. I suffered from extreme dryness and discomfort. I had no sex drive and was no longer able to experience an orgasm. Until, recently, when a friend told me about Courtney Albritton and
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I am a patient at Dr. Andrews!

I am a patient at Dr. Andrews! I highly recommend utilizing their services. Very thorough consultations, educational and informative. They give you lots of options to fit your needs and guide you through it. Amazing staff that is highly trained with the most up to date procedures and tools. I can't say enough about Dr. Andrews and his amazing staff!*
5.0
2016-09-28T15:22:01+00:00
I am a patient at Dr. Andrews! I highly recommend utilizing their services. Very thorough consultations, educational and informative. They give you lots of options to fit your needs and guide you through it. Amazing staff that is highly trained
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January 11, 2017

Dear Dr. Andrews,
Thank you so much for all you’ve done for me and my family. You are trustworthy, kind and personable. We really appreciate you and your talent. Thank you!*
5.0
2017-01-11T13:02:59+00:00
Dear Dr. Andrews, Thank you so much for all you’ve done for me and my family. You are trustworthy, kind and personable. We really appreciate you and your talent. Thank you!*

Amy Bonney Cejka

Just had my surgery from Dr. Andrews and everything is great!! He is the most kindest Dr. ever!*
5.0
2017-01-22T15:30:46+00:00
Just had my surgery from Dr. Andrews and everything is great!! He is the most kindest Dr. ever!*

You change peoples’ lives!

You change peoples’ lives! Words cannot express how much I love my new girls! Thank you so much for giving me exactly what I wanted. You are amazing!*
5.0
2017-02-24T14:28:06+00:00
You change peoples’ lives! Words cannot express how much I love my new girls! Thank you so much for giving me exactly what I wanted. You are amazing!*
1.0
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