Matching breasts
I have had a single mastectomy and am thinking about having a tissue expander put in. My question is does insurance have to pay to make the other breast look like the one with the expander and implant?
Hi - If you have group insurance that paid for the mastectomy, then that same insurance has to pay for an implant, plus any surgery to match your breasts. It's a federal law - here's more info. from one of our previous posts:
If your group insurance policy or HMO is covering your mastectomy, they also have to pay for reconstruction, and cosmetic surgery on the other breast to make them match—by law. Don’t let the insurance company tell you they won’t pay. It’s part of the federal Women’s Health and Cancer Rights Act of 1998, as follows: “Under WHCRA, group health plans, insurance companies and health maintenance organizations (HMOs) offering mastectomy coverage must also provide coverage for reconstructive surgery in a manner determined in consultation with the attending physician and the patient. Coverage includes reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas.”
Hope this helps - good luck. PJH
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PJ Hamel
Monday, October 26, 2009 at 07:18 PM
Yes, to play it safe and not get into a lot of paperwork, I'd think you should do this by the end of the year. Good luck - PJH
My experience has been that yes they pay for it as well.
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Thanks so much for your response, it is really helpful. I have an appointment with a plastic surgeon next week. If I decide to go ahead and have this done, depending on what the surgeon says, I am guessing I need to have it done before the end of the year, so the insurance will have to pay as I have no idea what insurance company my husband's employer will have next year.