How to Determine if Insurance Will Pay for Breast Reconstruction Surgery

Many insurance policies provide coverage for breast reconstruction surgery after a mastectomy, but it's important to check your policy to get the details.

Instructions

  • Step 1: Search for providers that are approved by your health plan. Choose one based on their availability and performance reviews.
  • TIP: Search online for performance reviews of providers.
  • Step 2: Consult with your doctor about the treatments that are covered by your insurance plan to decide what procedure, or combination of procedures and prosthetic devices, will best suit your needs.
  • FACT: Based on breast cancer rates seen in 2005 to 2007, 1 in 8 women will be diagnosed with breast cancer in their lifetime.
  • Step 3: Find out what level of co-insurance applies to breast reconstruction surgery under your plan. Co-insurance is the share of the cost that you must pay after you've met the deductible.
  • Step 4: Determine what your deductible is and how much you still owe for the year. The deductible is an amount of money you have to pay before the insurance company picks up the rest.
  • TIP: Medical plans in the U. S. that cover mastectomy procedures are generally required to cover reconstructive surgery and prosthetic devices following the surgery.
  • Step 5: Look up the coverage provisions and restrictions for breast cancer treatments and procedures in your medical policy manual and read it carefully.
  • TIP: Call the coverage or claims department if you are unsure about any of the specifics in the policy. The phone number is usually listed on the back of the health insurance card.
  • Step 6: Find out about your health insurance plan. If you do not have good insurance coverage on your own, see if you are eligible for government programs like Medicare.

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