Under the Women’s Health and Cancer Rights Act of 1998 (WHCRA), insurance companies are required to pay for breast reconstruction after a mastectomy or lumpectomy. The WHCRA also includes surgery of the unaffected breast to achieve balance and symmetry. Both natural tissue (flap) reconstruction and implant reconstruction are covered. Coverage is not affected by the timing of your reconstruction, whether immediate or delayed.
Although breast reconstruction must be covered by your insurance company, you may have to pay copays or deductibles based on your individual insurance plan. You’ll want to check with your company to find out what costs you might have to pay for related to breast reconstruction.
Unless you choose to pay out of pocket, you’ll also want to make sure that your Friedman Center surgeon and the hospital where you will have your surgery are in your insurance network. While your appointments with your plastic surgeon take place at the Friedman Center, you’ll have your surgery at one of our Northwell Health partner hospitals.
Your surgical coordinator can help you put together a list of questions for your insurance company.
Each physician at the Friedman Center has their own list of accepted insurance plans. These lists are maintained by the Northwell Health network.
View accepted insurance plans for our physicians:
Mark. L. Smith, MD, FACS
Armen K. Kasabian, MD
Lyle Leipziger, MD, FACS
Elizabeth Sieczka, MD
Neil Tanna, MD, MBA
Adam Perry, MD
Victor A. Moon, MD, FACS
Insurance coverage is subject to change. We recommend you check with your insurance company and your surgical coordinator at the Friedman Center to confirm coverage and details.
Medicare does cover breast reconstruction, while Medicaid coverage can vary from state to state. Check with your Medicare or Medicaid office to make sure you’re clear on the coverage and benefits you’re entitled to.
The WHCRA also requires insurance to cover postsurgical garments such as camisoles and bras after a mastectomy or lumpectomy. For women who choose not to have breast reconstruction, prostheses, balance forms, and pocket bras are also covered for the rest of your life. If you have had reconstruction, you’re still eligible for coverage for pocket bras (although the “pocket” will remain empty since the new breast already fills the cup).
Talk with your insurance company to see if any copays or deductibles apply, and make sure you purchase your bras from an in-network provider.