Facing a mastectomy is a life-changing experience, made worse by having to navigate through insurance coverage for different treatment options. Knowing your rights can help ease some of the uncertainty and provide comfort in knowing whether the mastectomy and reconstruction are covered. The Women’s Health and Cancer Rights Act (WHCRA) is a federal law that ensures coverage for individuals who choose to have breast reconstruction following a mastectomy. Under this law, eligible individuals are entitled to coverage for all stages of reconstruction of the breast affected by the mastectomy, as well as surgery and reconstruction of the unaffected breast to maintain a symmetrical appearance. Not only does the law ensure coverage in the rebuilding, but it also ensures coverage for physical complications resulting from the mastectomy such as lymphedema.

For the WHCRA to apply, the individual’s insurance must be part of a group health plan or provided in connection with such a plan. A group health plan typically refers to insurance offered through an employer, union, or association. Additionally, the insurance plan must include medical and surgical coverage for mastectomies, and the individual must have undergone a mastectomy and opted for breast reconstruction. If all of these conditions are met, then the WHCRA-required coverage applies.

Although the WHCRA provides essential protections, it does not require insurers to cover mastectomies. Instead, it mandates coverage for reconstruction only if the insurance plan already covers mastectomy procedures. Understanding these rights can help individuals make informed healthcare decisions. If you have questions about your coverage, consider reviewing your health plan or consulting a benefits specialist.