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To: FreedomNotSafety

“If she was any good she could have a practice not reliant on insurance”

Breast reconstruction is typically a mandated benefit.

Patients expect insurers to pay for most of the cost.

“The Women’s Health and Cancer Rights Act of 1998 (WHCRA) is a federal law that provides protections to patients who choose to have breast reconstruction in connection with a mastectomy.

“If WHCRA applies to you and you are receiving benefits in connection with a mastectomy and you elect breast reconstruction, coverage must be provided for:

“All stages of reconstruction of the breast on which the mastectomy has been performed;
Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
Prostheses and treatment of physical complications of all stages of the mastectomy, including lymphedema.”

“WHCRA requires group health plans and health insurance companies (including HMOs), to notify individuals regarding coverage required under the law. Notice about the availability of these mastectomy-related benefits must be given:
To participants and beneficiaries of a group health plan at the time of enrollment, and to policyholders at the time an individual health insurance policy is issued; and
Annually to group health plan participants and beneficiaries, and to policyholders of individual policies.”

https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/whcra_factsheet

NOTE: The page is probably outdated. The PPACA is based on “medically necessary”.


32 posted on 08/08/2025 10:10:28 AM PDT by Brian Griffin
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To: Brian Griffin

“Patients expect insurers to pay for most of the cost.”

More like... Patients expect anyone but themselves to pay for their care.


65 posted on 08/12/2025 7:18:14 PM PDT by FreedomNotSafety
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