It is best for you to contact your insurance provider up front and have a clear understanding of what is covered.
Here are some questions to ask your health insurance plan about your coverage:
Am I covered for a mastectomy? Remember: if a mastectomy is covered then they are required to cover both reconstructive surgery and/or prostheses for both breasts.
Do I have a limit on how many ‘second opinions’ are covered?
Do I need a preauthorization for my surgery?
Do I need to use a surgeon, hospital and services in my network?
What are my expenses if I choose a surgeon outside my network?
What if my network surgeon doesn’t specialize in a specific technique that I want? What expenses are and are not covered?
How many days of my hospital stay are covered?
Are all providers involved in my surgery and hospital stay covered? Remember: there can be many providers involved including doctors, hospitals and laboratories who may bill separately or together.
Some additional questions you may have about the Woman’s Health and Cancer Rights Act of 1998:
Are there any exceptions to the Woman’s Health and Cancer Rights Act of 1998 (WHCRA)?
Yes, per the Department of Labor, there are a few types of employers who have self-insured plans that could be exempt. They include: local school districts, churches and states. However, there are still some protections and benefits coverage that could apply.
What if my insurance company covers less than my doctor charges?
You can ask your doctor and hospital providers in advance if they accept rates set by your health insurer and ask if you will be billed the difference.
What if I change insurance companies after my mastectomy?
It’s not too late! Your WHCRA right to breast restoration after a mastectomy transfers to your new insurance coverage.
Who can I call about my WHCRA rights?
You can call the US Department of Labor Employee Benefits Security Administration at (866) 444-3272. They are a good resource for information about your WHCRA rights.