Does Insurance Pay for Breast Reconstruction Surgery with Heather Karu, M.D.
Heather Karu, M.D., a plastic surgeon at Sanford Health, talks about if insurance pays for breast reconstruction surgery for patients who have breast cancer surgery. If a patient has undergone a mastectomy, the Women’s Health and Cancer Rights Act of 1998 protects them and says that if your insurance covers mastectomy, then they must cover reconstruction surgery as needed for symmetry. It’s important for general surgeons to obtain pre-authorization for the mastectomy. However, the rest is covered by law. In rare cases of dispute, plastic surgeons can send a copy of the law and appeal to the insurance provider. Patients who have lumpectomies (also called a partial mastectomy) may find their insurance provider considers this a gray area. However, most insurance companies understand that the procedure is cancer related and due to something that was not the patient’s choice (in contrast to cosmetic plastic surgery where the patient does not have an underlying medical reason for the surgery). Also, insurance usually pays for revisions (additional breast surgery). Patients have options and there are foundations and websites that offer support if breast cancer patients are having a difficulty with their insurance provider.