Will My Insurance Cover Breast Reconstruction Surgery After a Mastectomy?

For Houston women, facing a mastectomy can be a very scary and emotional time. While it can be a life-saving procedure, it also changes the look of a woman’s body forever. Not to mention, there’s the added stress of medical bills from breast cancer treatments and loss of income due to time off of work for treatments. And for many Houston women who want breast reconstruction after their mastectomies, they are left wondering, and worrying – “Will my health insurance pay for my breast reconstruction?”

The Answer is Most Likely Yes!

Rest assured, in most cases; your insurance company will pay for your Houston breast reconstruction surgery after a mastectomy. Nearly 20 years ago, Congress passed the Women’s Health and Cancer Rights Act of 1998, which requires any group health plan that pays for a mastectomy to also pay for breast reconstruction surgery, whether that breast reconstruction surgery happens immediately or years later. Additionally, Medicare will pay for breast reconstruction surgery. If you’re on Medicaid, however, breast reconstruction surgery varies state by state, so whether you’re in Houston, the coverage may differ.

Are There Any Insurance Restrictions?

There may be some restrictions placed on breast reconstruction surgery by the state of Texas. The best thing you can do to ensure that you do not get stuck with an expensive bill for breast reconstruction is to contact your insurance company to get an Explanation of Benefits (EOB) and also to work with the person in your Houston plastic surgeon’s office who handles health insurance billing. While your insurance is required to pay for your breast reconstruction surgery, you’ll need to work with an in-network plastic surgeon to receive the best financial benefit from your insurance company.  While your insurance will likely cover the surgery, this does depend on what your deductible is and whether you have met that deductible prior to surgery. For questions regarding your deductible, please contact Dr. Fusi and Dr. Craig’s office for additional guidance.

Will I Have to Pay Anything Out of Pocket?

While the law requires your insurance company to pay for your Houston breast reconstruction surgery if they also pay for your mastectomy, the entire procedure may not be free. You will still have to follow your health insurance’s plan rules, which means you’ll still be responsible for paying any co-pays or deductibles. But if you’re undergoing a mastectomy and have had other recent cancer treatments, it’s highly likely that you’ve already met your annual deductible.

Do Dr. Fusi & Dr. Craig Accept My Insurance?

If you’re interested in having breast reconstruction surgery by Houston doctors Dr. Fusi or Dr. Craig, your first step should be calling the office at (713) 346-9909. By speaking with our office staff, you’ll be able to determine whether or not we accept your particular health insurance plan. If we do, we recommend that you come in for a consultation with Dr. Fusi or Dr. Craig so that we can discuss the post-mastectomy breast reconstruction procedure, including whether you want breast reconstruction with implants or with your own body’s tissue.  Don’t wait.

Call today to get your Houston breast reconstruction process started.