Your Insurance and Financial Options for Breast Reconstruction: Know Your Options

Post by Gail Lanter, CPC Office Manager

Image to the left taken from The United States Department of Labor website.

A large part of my day is spent answering questions for women who are exploring their breast reconstruction options. These ladies are all potential patients of our practice and my mission is to help them make educated, informed decisions regarding a procedure, location, and time that are right for them. Ultimately, the discussion always turns to the insurance and financial part of the surgical procedure.

I’ll be honest. Sometimes the questions are surprising and a bit alarming when it comes to this end of things. There are women out there who are not aware of WHCRA 1998, the law that empowers women to elect to have the breast reconstruction procedure of their choice. In short, it states that if their insurance company covers mastectomy . . ., they have to cover your elected breast reconstruction procedure and any procedure required to achieve symmetry if you only have one affected breast.

Of course, just like anything else, there are always exceptions, but I would venture to say it covers the majority of women in the U.S. Read it here. It’s a law designed to protect your rights, and it’s important to know if you have had or are facing mastectomy.

***It’s not cosmetic surgery. Plastic surgery for breast reconstruction after mastectomy is a functional issue, not a vanity item. You don’t have to have artificial implants if you don’t want them. The options are endless. Sure, some women are limited in their options, simply because there are medical and health issues some women face that may not make them candidates for some of the surgical procedures. But in general, there is something out there for just about everyone. It’s not a one- time shot either. You’ve tried implants, great, they worked out for you and you are happy. HOORAY! DONE!

If you’ve tried them and they didn’t work out, (i.e. you developed capsular contracture, a post operative infection, couldn’t bear the tissue expansion process, whatever the reason) you can choose to go another route. It’s completely up to you. Read, go online, ask your friends, ask someone in your support group, and get a 2nd and 3rd opinion. Sometimes it’s not easy to find the alternatives, but sooner or later you will find something that works for you. Ask a bunch of questions, and in turn, you’ll get a bunch of answers and opinions to consider. Don’t be afraid to travel—sometimes your local surgeon may not offer all of the breast reconstruction techniques that are available, new ones are developed all the time.

Think of it this way: I’m an excellent softball player, but if you are looking for someone for your basketball team, I’m not your girl. But, being a good pal, I’ll ask around and find you someone who will be a wonderful addition to your team. It’s what friends do for one another.

So ask your current surgeon, tell him or her that as much as you appreciate all they have done for you, you’d like to know if there are procedures available beyond what they offer. If they are good guys / girls, they’ll lead you in the right direction if they are out of options for you.