Does insurance have to cover breast reconstruction surgery?

It’s awful how insurance all they want to do is deny. But you would think the surgeons would help

Talk to your insurance company about coverage. You can send them the bill but they may only pay the “contracted amount” they would pay the physician

I have surgery scheduled at a university teaching hospital 5-6hr drive away. They have surgeons who will accept insurance. But I will need to stay a few days post op in case of any complications since I live so far away...

Hi Jessica I don't know if this is for every state, but in Massachusetts, they have to cover the reconstruction even if you put it off for a while. Yes, call your insurance company. Try to get a patient navigator who can assist you with this. Don't give up. It's ridiculous that we need to worry about this on top of already going through this. Susan G. Komen Foundation. National Breast Cancer Foundation. Best of luck to you always

It is not a matter of the insurance company covering it: I have great insurance and my husband has great insurance for anything mine doesn't cover (ie copays). The problem is NO PLASTIC SURGEONS in my city TAKE insurance, it is cash only. Disgusting, 💰 money hungry doctors! So unless you pay cash, there is not a plastic surgeon that will do reconstruction surgery. Thus I need to drive 6hours away for surgery...

That is unbelievable for such a large state! What greedy bastards. Are there any other cities closer to you that you may be able to get a surgeon?

I live in NJ and I was told mine was covered up to 10 years. The only thing not covered is nipple tattoos by a private artist. I have no clue what they are going to do to me. I know you can buy paste on nipples.

Yes, federal law requires most insurance plans to cover breast reconstruction surgery after mastectomy, including the Women's Health and Cancer Rights Act. The frustrating situation described here - where insurance must cover the procedure but finding participating surgeons is extremely difficult - unfortunately reflects broader healthcare access challenges that many patients face. It might be worth contacting the insurance company directly to ask about expanding their network or seeking pre-authorization that could encourage more surgeons to accept the coverage, and patient advocacy organizations may also have resources to help navigate these barriers.