INSURANCE COVERAGE FOR BREAST RECONSTRUCTION AFTER MASTECTOMY

Actress, humanitarian and mother, Angelina Jolie recently detailed her decision to undergo a preventative double mastectomy and reconstruction surgery in an op-ed in the New York Times. The reason cited for her decision was the result of a genetic test that revealed she carries the BRCA1 gene mutation that makes her five times more likely to develop breast cancer and 10 times more likely to develop ovarian cancer.

The American Cancer Society estimates that just under 40,000 people across the U.S. will die of breast cancer in 2013. A statistic like that may make it seem like following in Jolie’s footsteps and undergoing a preventative mastectomy is the best way to ensure that you are not part of that statistic. In response to the op-ed, health care professionals have come forward with additional important information – less than 2 percent of women should even consider getting the genetic testing that Jolie did to screen for BRCA1 or BRCA2 and that one of the best indicators of a predisposition for breast cancer – or any type of cancer – is looking at your family history.

Genetic testing aside, for those women (and men) who have faced a breast cancer diagnosis and have undergone a mastectomy as part of a cancer treatment plan, the Women’s Health and Cancer Rights Act requires insurance companies to cover reconstructive surgery after breast removal.

Enacted in 1998, the WHCRA requires insurance companies to cover the reconstruction of the breasts after a double mastectomy or the reconstruction of the removed breast and any necessary work to the original breast necessary to create symmetry and balance. The California Insurance Code also specifically requires coverage of prosthetic devices or reconstructive surgery after a mastectomy for treatment of breast cancer.

Of course, whether a preventative mastectomy and reconstruction is covered in the same manner as a mastectomy and reconstruction completed as a cancer treatment plan is something to discuss with your insurer and possibly an insurance coverage attorney before moving forward.

If you have undergone a mastectomy for breast cancer treatment and been wrongfully denied insurance coverage for reconstruction, you should also seek experienced legal counsel.

Source: American Cancer Society, “Women’s Health and Cancer Rights Act”