Will insurance cover Revision Surgery after breast cancer?
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To answer this, let's first refer to the "Women's Health and Cancer Rights Act." It states:
"Group health plans, insurance companies, and health maintenance organizations (HMOs) must provide coverage for reconstructive surgery after mastectomy for breast cancer and prohibited "drive-through" mastectomies, where breast cancer patient's hospital stays were limited by their carriers. The required coverage includes all stages of reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, prostheses, and treatment of physical complications of the mastectomy, including lymphedema."
More simply put, YES. Insurance carriers are legally required to cover revision surgery. There are some spots where it gets complicated, though.
If you are not happy with the initial reconstruction of your breasts, they are not obligated to cover repeated revisions and do reserve the right to deem the procedure "not medically necessary." There now needs to be a clear medical reason to perform the revision surgery to have the best chance of being approved.
If you'd like to look deeper into the "Women's Health and Cancer Rights Act," you can do so here:
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