Unfortunately, breast reconstruction isn’t always the end of a breast cancer battle. Many women are unhappy with their breast reconstruction after a mastectomy, whether immediately or years later. They may have had a poor initial result or developed complications with age.
Luckily for New York state insurance policyholders, some provisions ensure you have the right to revision breast reconstruction if you’d like to improve your results.
Unhappy With Breast Reconstruction After a Mastectomy? Here’s Why
Breast reconstruction following a mastectomy is a delicate process that requires working with already traumatized tissue. Even a perfectly performed surgery may have issues down the road, if not immediately after. To give you a better idea, the table below lists some of the various issues you could face in the weeks or years following breast reconstruction surgery:
|When it occurs
|Bacterial or fungal infection causing redness, pain, and swelling
|Scar tissue tightens around the implant, distorting the breast
|Shifting or unnatural positioning of the breast implant
|Implant breakage or leakage of saline or silicone gel
|Death of fatty tissue resulting in lumps or hardness
|Buildup of fluid around the implant causing swelling and pain
|Infections occurring after the initial healing period
|Formation of a bacterial layer on the implant surface
If you’re unhappy with your breast reconstruction after a mastectomy, one of the reasons above is the likely culprit. Even the best surgeries can result in complications down the road as your body ages and changes. That’s why insurance coverage for your revision breast reconstruction is built into the original policy language that covered your first surgery.
Getting Revision Breast Reconstruction Covered Under Insurance Policies
Many insurance policies for people in New York will cover a revision surgery if you are unhappy with the breast reconstruction you had after your mastectomy. In fact, both federal and New York state laws already require this coverage. Specifically, you’re protected by two rules:
- The Women’s Health and Cancer Rights Act (WHCRA) of 1998: This act requires coverage for “treatment of physical complications of all stages of the mastectomy.” A poor result from a mastectomy would be considered one of these complications.
- New York Insurance Law § 3216: This state law also mandates coverage for all stages of breast reconstruction, with revision reconstruction being one of those stages.
These two laws protect your right to a revision if you’re unhappy with your breast reconstruction after a mastectomy. However, simply knowing these laws is a lot easier than navigating their particulars. If you’re interested in breast reconstruction, here is what you need to do next.
Consult With Your Surgeon
Before undergoing a revision breast reconstruction, it is crucial to consult a specialist with experience performing this type of procedure. During a consultation, you’ll discuss the issues you’re experiencing and the results you hope to achieve. It’s important to provide specific details about your concerns and goals. Your surgeon will take the time to get to know you and understand your expectations before conducting a thorough examination and creating a detailed surgical plan tailored to your individual needs.
Obtain Supporting Documentation
To demonstrate the medical necessity of your revision breast reconstruction, your surgeon will help you gather relevant medical records. These may include details of your initial reconstruction surgery and related follow-up notes. These essential records will help your surgeon understand the specifics of your previous surgery and adapt the best possible surgical approach for your revision.
Obtain a Pre-Authorization
Once your surgeondevelops a comprehensive surgical plan, their office will contact your insurance provider to inquire about the pre-authorization process for revision breast reconstruction surgery. This usually involves submitting all necessary documents, including the surgeon’s recommendations, to obtain approval from your insurance provider for the planned surgery. Pre-authorization ensures that your insurance covers the procedure, subject to any applicable terms and conditions.
Review Out-of-Pocket Costs
While insurance is typically required to cover the cost of your revision breast reconstruction surgery, it’s important to be aware of potential out-of-pocket expenses. These can include copays, co-insurance, or deductibles that you may be responsible for paying. To help you prepare financially, your surgeon’s patient care representative will guide you through the process and provide details about any anticipated out-of-pocket costs associated with your surgery. This step ensures that you clearly understand the financial aspects involved and can plan accordingly.
If you’re unhappy with breast reconstruction after a mastectomy, you have options. A skilled surgeon can perform a revision breast reconstruction, and an expert patient coordination team can help you cover the insurance side. Many insurance policies include the coverage you need to get the result you want; you just need to know how to use it.
Joanne Parrinello, Practice Manager
Joanne Parrinello is an expert patient care coordinator, with two decades of experience navigating the complex financial side of medically necessary breast reduction and reconstruction surgery. She acts as a guide to patients, helping them understand their options and their expected out-of-pocket expense. The insurance industry can be complex and filled with jargon that makes you feel like you need a translator. At Harris Plastic Surgery, Joanne is that translator.