Insurance Coverage

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Breast Reconstruction Insurance Coverage

As a breast reconstruction patient you are beginning a life-changing journey that is both stressful and oftentimes uncertain. You may undergo cancer surgery, reconstruction, chemotherapy, and radiation. Treatment is a multi-staged process and may last 6 to 12 months. You will be treated by numerous medical professionals along the way and facilities that will bill your insurance company for your treatment. Dr. Zemmel and the Richmond Aesthetic Surgery Team recognize that navigating today’s healthcare system can be very difficult and frustrating. Our team at Richmond Aesthetic Surgery will assist you in any way possible to make this part of the journey as smooth as possible.

Prophylactic mastectomy (preventative mastectomy) is almost always covered as well. Patients undergoing prophylactic mastectomy usually have an extensive family history of breast cancer or are BRCA1/2 positive (genetically positive). Again once your insurance carrier agrees to cover the mastectomy federal law mandates coverage for the reconstruction.

One of the more frequently asked questions posed by our patients is whether or not breast reconstruction is covered by insurance. The 1998 Women’s Health and Cancer Rights Act guarantees by federal mandate breast reconstruction after a lumpectomy or mastectomy in the setting of cancer or other benign tumors.

American Cancer Society Website Summarizing the Law

Not only does the WHCRA law cover reconstruction of the absent breast but it also covers any symmetry matching procedures including mastopexy (breast lifting), breast augmentation, or breast reduction. It also covers reconstruction of the nipple and final areola tattooing.

Many patients elect for an implant based reconstruction. While today’s breast implants are very safe, no implant is a lifetime device. All patients should expect to replace them at some point in the future. Many patients ask if future implant maintenance/replacement is covered by insurance, and of course the answer is “yes.”

Once you become a breast cancer/reconstruction patient insurance must cover you treatment for your lifetime.

If you have any questions regarding your insurance plan or coverage of breast reconstruction, please do not hesitate to call our offices or discuss these issues with Dr. Zemmel during your initial consultation.