Lesser-known law may pay for breast reconstruction

Women’s health coverage took a step forward when the 1974 Employee Retirement Income Security Act (ERISA) was amended in 1998.

The Women's Health and Cancer Rights Act (WHCRA) requires reconstructive surgery and other post-mastectomy measures to be covered by group health plans if they also cover mastectomies for breast cancer or other medical reasons.

The worlds before and after WHCRA

Before WHCRA, breast reconstruction was widely seen as a cosmetic procedure and not medically necessary, according to an article in the Texas Medical Center News.

Insurance claims for reconstructive surgery were often denied, with carriers asserting that breasts do not serve a bodily function and a woman’s health was unaffected by their loss.

Dr. Margaret S. Roubaud, reconstructive plastic surgeon at the University of Texas Anderson Cancer Center, said “The fact that, for years, we cut off women’s breasts and didn’t offer them anything seems to be a little archaic.”

She now sees many reasons for hope.

“When [patients] come into my office or my clinic and everyone’s clinic in this department, they all are looking for some way to feel whole again. We get to deliver that.”

Too little education on breast reconstruction

Nearly 270,000 new cases of invasive breast cancer will be diagnosed in American women in 2019, according to estimates from the American Cancer Society.

Not all these diagnoses lead to mastectomies, and not all women who undergo mastectomies elect to have reconstructive surgery.

But those who choose reconstruction commonly report quality-of-life and psychosocial benefits, according to the American Society of Plastic Surgeons (ASPS).

The ASPS described in 2017 a steady rise in the number of women electing breast reconstruction, including a 2000 to 2016 increase of 39%.

While this rate of increase is striking, what may be more surprising is that most women who require mastectomies are never offered breast reconstruction surgery, according to ASPS.

They cite studies indicating that only 23% of women understand their various breast reconstruction options.

These 2017 statistics on awareness may have changed somewhat. October 2016 saw the implementation of the Breast Cancer Patient Education Act signed by President Obama.

The law’s purpose is to increase awareness among breast cancer patients about breast reconstruction and prostheses and the possibilities for covering the costs.

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