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Paying for Cancer Screening and Prevention

Locate medical experts and find information on insurance coverage and financial assistance for risk management, treatment and follow up care.

Paying for breast reconstruction

The Women's Health and Cancer Rights Act requires insurance companies that cover the cost for mastectomy to also pay for the following services after mastectomy:

  • breast prostheses
  • breast reconstruction
  • surgery to the other breast to achieve a symmetrical appearance
  • treatment for complications from mastectomy or reconstruction

Despite the law your initial request for reconstruction may be denied. If you belong to a managed care plan, your insurer will most likely approve your request for procedures performed in-network (with surgeons already contracted by the insurance company). However, you may face difficulties with reimbursement if you want or need to go out-of-network for reconstruction. You’ll have to prove why in-network services or physicians do not meet your needs. You may prefer not to have breast implants, for example, when that is the only breast reconstruction available in-network, or you may only have sufficient tissue for a GAP procedure, which may not be performed by in-network physicians.

Most hospitals have social workers or financial assistance counselors who can help explain your options and direct you to resources which provide assistance in paying for medical care. Some hospitals designated as Hill-Burton facilities receive money from the federal government. These hospitals must provide a certain amount of free or reduced-cost health services every year to those who cannot pay. Each facility may decide which type of free or reduced-cost care it will provide, and must publish this information in the newspaper, as well as provide a written notice to you upon request for Hill-Burton Assistance.

If your insurance company denies these services, visit our health insurance appeals page for information on insurance appeals. 

 

Updated 08/22/15

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