Will insurance cover reconstruction? Is it cosmetic?
Breast reconstruction is not considered cosmetic surgery. Under the Women's Health and Cancer Act of 1998, group health plans, insurance companies, and HMO's that offer mastectomy coverage must also provide coverage for reconstructive surgery after mastectomy. This coverage includes reconstruction of the breast removed by mastectomy, reconstruction of the other breast to produce a symmetrical appearance, breast prostheses, and treatment of physical complications at all stages of the mastectomy, including lymphedema. This law sets a federal standard so that women can obtain breast reconstruction following mastectomy even if they live in states that do not require insurance companies to provide this coverage.
In many cases, reconstruction to fix a lumpectomy deformity will also be covered by insurance. It is important to check with your individual provider to find a surgeon in your network that meets your reconstruction needs.
If your insurance carrier denies approval to have the type of reconstructive surgery you desire, with a specific surgeon of your choice, you can appeal. In most cases, your surgeon’s staff should be able to help you in this process. Remember, the law is on your side.
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