Breast cancer is a devastating disease that affects millions of women worldwide. In the United States alone, there are over . While the survival rate for breast cancer has significantly improved over the years, many women still face challenges during and after their treatment.
One of these challenges is the cost of breast reconstruction surgery.
Breast reconstruction is a surgical procedure that rebuilds the shape and appearance of a woman's breast after undergoing a mastectomy (removal of one or both breasts) or lumpectomy (partial removal of the breast). This procedure can help women regain their confidence and feel more like themselves again. However, the cost of breast reconstruction surgery can be a major barrier for many women.
Fortunately, the Women's Health and Cancer Rights Act (WHCRA) was passed in 1998 to address this issue.
Understanding the Women’s Health and Cancer Rights Act
The, also known as Janet's Law, is a federal law that was passed in 1998. It requires all group health plans that cover mastectomies to also provide coverage for breast reconstruction surgery. In other words, any woman who has had a mastectomy is entitled to have her health plan cover the cost of her breast reconstruction surgery.
Before WHRCA was passed, only a few states had laws requiring insurance companies to cover breast reconstruction surgery. This left many women without coverage, causing financial strain and limiting their access to this important procedure, including a young woman from Long Island named Janet Franquet.
Janet was diagnosed with an aggressive form of breast cancer in 1997. She had to undergo a mastectomy and chemotherapy before she could even consider reconstructive surgery. However, when her surgeon, Dr. Todd Wider, contacted her insurance carrier, he learned that the plan considered breast reconstruction to be cosmetic and refused to cover it. Instead, they recommended a less expensive skin graft.
Dr. Wider performed the procedure for free, but in an effort to make sure no other woman would have to experience what Janet did, he decided to take action. He reached out to politicians, including Senator Alphonse D'Amato, who became an outspoken advocate for legislation that would change the law.
Thanks to Dr. Wider's advocacy and Senator D’Amato’s leadership, WHCRA was passed at the federal level with overwhelming bipartisan support.
What Does WHCRA Cover?
WHCRA covers all aspects of breast reconstruction surgery, including:
- All stages of reconstruction of the breast on which the mastectomy was performed.
- Surgery and reconstruction of the other breast to produce a symmetrical appearance (if requested).
- Prostheses (breast forms), bras, and other devices needed for post-mastectomy care.
- Treatment of physical complications resulting from mastectomy, such as lymphedema.
This coverage is not limited to only immediate reconstruction after a mastectomy. It also covers delayed reconstruction, which means that women can choose to have the procedure at a later time if they are not ready for it immediately after their mastectomy.
What is Not Covered Under WHCRA?
While WHCRA mandates coverage for breast reconstruction surgery, some out-of-pocket expenses may not be covered. These can include:
- Procedures unrelated to breast cancer, such as breast augmentation or reduction.
- Deductibles or co-insurance amounts.
- Cost of travel, lodging, and other personal expenses.
- Any complications unrelated to the reconstruction procedure.
It is important to check with your insurance provider about the specific details of your coverage.
Limitations of WHCRA
WHCRA provides essential protections for women seeking breast reconstruction surgery, but it does have some limitations. These include:
- If you choose to have your reconstruction surgery done by an out-of-network provider, you may not receive full coverage under WHCRA.
- It does not cover the cost of preventive mastectomy or contralateral prophylactic mastectomy (removal of a healthy breast on the opposite side).
- It may not cover all reconstruction techniques, such as (nerve reconstruction). Coverage for Resensation varies from plan to plan, so check with your insurance provider first.
- It does not cover cosmetic procedures related to breast reconstruction, such as by a non-medical tattoo artist.
Take time to review your specific insurance plan's coverage and limitations carefully to ensure you understand what is and isn't covered.
Regain Your Confidence with Us
Fighting breast cancer is already challenging, and the cost of breast reconstruction should not be an added burden. As a patient, it is essential to know your rights and options for accessing coverage for breast reconstruction surgery. WHCRA is there to protect and support you in this journey, and so is the team at .
Our experienced surgeons specialize in natural breast reconstruction using your body's own tissue, without the use of implants or synthetic materials. We also offer a variety of supportive services, such as Resensation® and 3D nipple tattooing, to help you regain your confidence and feel like yourself again. Book a consultation with us today and let us be a part of your journey towards recovery and self-empowerment.
Frequently Asked Questions
Can I choose any type of breast reconstruction?
The type of breast reconstruction available to you will depend on various factors, including your body shape, medical history, and personal preferences. Your surgeon will discuss the options with you and help determine which approach is best suited for your needs.
Will my insurance cover all the costs associated with breast reconstruction?
While WHCRA requires insurance plans to provide coverage for breast reconstruction surgery, there may be some out-of-pocket costs that are not covered, like travel, coinsurance or deductibles. It is essential to check with your insurance provider about the specifics of your coverage and any limitations.
My health coverage is through an individual policy, not through an employer. What rights, if any, do I have under WHCRA?
Individual policies are also subject to WHCRA's requirements, so you have the same rights and protections as those with employer-based coverage. However, you should always review your specific policy and speak with your insurance provider if you have any questions or concerns about coverage for breast reconstruction surgery.
If you encounter any issues, you can also seek assistance from the Department of Health and Human Services toll-free at 1-877-267-2323, extension 61565, for further information.
What should I do if my insurance company denies coverage for breast reconstruction?
If you believe your rights under WHCRA are being violated, you can file an appeal with your insurance company or contact the Department of Labor's Employee Benefits Security Administration for assistance. Additionally, seeking legal advice may help navigate this situation.