Breast Reconstruction Insurance Coverage

The Federal Women’s Health and Cancer Rights Act of 1998

The Women’s Health and Cancer Rights Act (WHCRA) contains important protections for women with breast cancer who choose to have breast reconstruction after a mastectomy. It was signed into law on October 21, 1998. The US Departments of Labor and Health and Human Services have oversight of this law.

WHCRA:

• applies to group health plans for plan years starting on or after October 1, 1998
• applies to group health plans, health insurance companies and HMOs, if the plans or coverage provide medical and surgical benefits for a mastectomy

Under WHCRA, mastectomy benefits must include coverage for:

• reconstruction of the breast on which the mastectomy was performed
• surgery and reconstruction of the other breast to produce a symmetrical or balanced appearance
• the prostheses (or breast implant)
• any physical complications at all stages of mastectomy, including lymphedema

Mastectomy benefits may have a yearly deductible and coinsurance (a form of insurance in which health costs are insured for less than the full amount and the patient is responsible for the difference) but they must be like those established for other benefits under the plan or coverage.

Esther has advanced training in post mastectomy areola tattoo (areola micropigmentation) and will gladly provide you with the needed invoice for reimbursement from your insurance company

You may make contact your insurance company and they are obligated to send you the forms for reimbursement for areola tattoo. If you need to, please remind them that this is the law and the link above will bring you to a website that will provide you with all pertinent information.