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Does Insurance Cover Breast Reconstruction?

As discussed in our blog last month, a Cancer Support Community (CSC) survey found that almost half of women with breast cancer did not receive information about breast reconstruction when reviewing treatment options. The outcome of this survey is shocking, especially given that due to the Women’s Health and Cancer Rights Act (WHCRA) of 1998, insurance companies must cover the costs of breast reconstruction surgery if they cover the costs of mastectomy. While many patients are not clear on the specifics of what their health insurance covers, it seems odd that providers would not be familiar with WHCRA, as it is a federal act and therefore applies to all health insurance organizations—public and private—in all states. Additionally, WHCRA deals with common and well established procedures (mastectomy and breast reconstruction), is available for patients with the most well-known and publicized type of cancer (breast cancer), and received significant media coverage during its passage. Determining why providers are not discussing breast reconstruction with their patients is an important next step to ensuring that these conversations happen. If lack of knowledge is the main reason for the dearth of conversations, then perhaps the CSC, or some other organization, can create a new resource to inform providers. This provider resource could serve as a parallel of and/or work in conjunction with the CSC’s new national program, “Frankly Speaking about Cancer: Spotlight on Breast Reconstruction,” which offers comprehensive information about breast reconstruction as a way to empower patients. Some providers may know about WHCRA but generally not mention breast reconstruction to their patients because they do not see it as part of their role (e.g. they are oncologists, not plastic surgeons; they are nurses, not physicians). These providers could benefit from the Oncofertility Consortium model of bringing together experts from a variety of disciplines in order to ensure patients receive the best and most complete cancer care.

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