Insurance Information

Although finances are the last thing you should have to worry about when dealing with the larger issue of your health, the question of how much your breast reconstruction may cost remains a concern for many women. In the United States, health insurers offering coverage for breast cancer treatments are also required to cover breast reconstruction by federal law.

Insurance Information

Board certified plastic surgeon Dr. Michael Halls is well-known throughout the San Diego area as a breast reconstruction specialist. Dr. Halls and his expert staff are skilled at helping patients to navigate their insurance policies in an effort to make your reconstructive procedure as stress-free as possible. In addition to breast and nipple reconstruction, Dr. Halls also offers a full range of cosmetic breast enhancement procedures for women who want to enhance their figure.

Please contact us online or call La Jolla Breast Institute today at (858) 458-0100 for more information on insurance coverage for your reconstructive breast surgery, or to schedule your breast reconstruction consultation.

The Women’s Health and Cancer Rights Act

The Women’s Health and Cancer Rights Act (WHCRA) was passed in 1998 as a protection for the many women with breast cancer who choose breast reconstruction after a mastectomy. This federal law mandates reconstructive breast surgery coverage by those insurance plans that also cover mastectomies and lumpectomies.

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The WHCRA applies to any insurance policy starting on or after October 1, 1998, whether health insurance company, HMO or group health plan. Benefits covered under the WHCRA include:

  • Breast reconstruction of the breast or breasts removed by mastectomy
  • Balancing procedures performed on the opposite breast that are necessary to create symmetry with the reconstructed breast
  • Coverage of external breast forms that are required before or after breast reconstruction
  • Cost of the implant or implants required during surgery
  • Treatment of any physical complications that may occur during the mastectomy or reconstructive surgery, including lymphedema

Many states have different laws that extend or further define these benefits in some cases. For example, the majority of health insurance companies also cover contour correction of the breast following a lumpectomy.

At the federal level, WHCRA is intended to hold states with weak or no protection for women with breast cancer to a minimum standard. The WHCRA also requires health insurance companies to notify policyholders of their coverage at the time of enrollment, and every year after.

Breast reconstruction is still subject to the yearly deductible and coinsurance terms already set forth in your policy, although WHCRA does require those amounts to be in the same range as those already established for similar benefits under the same health insurance plan.

You can call Dr. Halls’ staff directly at (858) 458-0100 to help answer any questions you may have about your insurance coverage, or you can contact the U.S. Department of Labor at (866) 487-2365, your State Insurance Commissioner’s office or your insurance provider.