Reconstruction Rights in this blog do not refer to buildings or architecture. These rights are much more personal. They refer to women’s options and rights for breast reconstruction after mastectomy or lumpectomy.
In the coming week, we have a Day to celebrate the awareness of these options and rights: BRA Day, on Oct. 18, this year. By the way, the letters of the day, “B.R.A.” symbolize these words: Breast Reconstruction Awareness Day.
The Breast Reconstruction Awareness Day began in 2011 in Canada. at that time, many women were completely unaware of the options after mastectomy. Now, over a decade later the day, Breast Recon DDay is internationally recognized. And this year brings women the 11th annual Bra Day.
“Breast Reconstruction Awareness Day is an awareness campaign designed to put an end to the unknown by promoting public education, patient care and research.”
Breast Reconstruction: Getting Right To The Heart of the Matter
We are all aware that October means the pink ribbons of Breast Cancer Awareness are in full bloom. Breast Cancer Awareness fills many minds and hearts during this time.
Next Wednesday you might discover that “families and friends,” of breast cancer patients choose to “coordinate events on the special day…” They might be involved in media events, foot races, lectures, fund-raising parties and other community events.
Cancer Surgery, Breast Reconstruction, and You
Because Dr. Orlando Cicilioni is deeply committed to the cause of gentle and beautiful breast reconstruction for breast cancer survivors, this is a cause dear to our hearts at Altiora Plastic Surgery and Medspa.
We join American Society of Plastic Surgeons, The Plastic Surgery Foundation, and many plastic surgeons specializing in breast surgery. All of us carry this cause close to our hearts. You will also find nurses, corporations, breast support groups, and many other local community organizations involved and committed. They are dedicated to patients getting the information needed to make reconstruction decisions. They have all pledged to make extra efforts to be sure you understand your breast reconstruction options.
Breast Reconstruction Legislation: Getting To the Legal Heart of the Matter
It is a sad fact that many women have plunged into their breast cancer decisions without full awareness of their breast reconstruction options.
At Altiora Plastic Surgery, we understand the urgency and distress that follows a cancer diagnosis. We realize patients are not thinking about legal rights, insurance, personal appearance, or what comes after the cancer is cut away. That is why we have pledged to get the word out about your rights and your options. That is one of the big reasons for the existence of blogs such as this one.
Know Your Insurance Reconstruction Coverage Rights: The Women’s Health and Cancer Rights Act
In the mental anguish of the immediate time of your diagnosis, we know you are not really thinking about details. These details involve how you will financially cover the mastectomy or lumpectomy charges plus reconstruction. You only know, in a dizzy blur, there will be bills from the lab, the surgeon, the anesthesiologist, the surgical assistant, the hospital, and others.
Our BRA Day, the crusade is for you and every woman to understand your basic rights. You need to know your breast reconstruction choices. We want you to be aware of your options before you are in a life-threatening situation, facing mastectomy. And we can hope you will never need the information.
You might think that your insurance would view reconstruction surgery as cosmetic surgery with no medical necessity. You might think your insurance company would take no responsibility for it. There was truth in this assumption before 1998. Claims were actually denied. Patients paid for their own reconstruction.
“Many women were stuck with an often dramatically altered physical appearance because they couldn’t afford to pay the plastic surgeon…” And they assumed their insurance would not care about breast reconstruction and would not help them pay for more surgery.
Congress Recognizes Value of Breast Reconstruction: 1998’s Gift to Women-WHCRA
That concept is decidedly out of date. Congress passed The Women’s Health and Cancer Rights Act (“WHCRA”) 1998. We are still proud of the Congressional leaders and sponsors of the bill. They realized that many women could not achieve well-being if they did not have options for reconstructive surgery after a mastectomy. And they have a legal right to know what the options are.
The legislation referred to as “WHCRA” created rules and provisions that concern every woman. The laws specifically pertain to “benefits for breast reconstruction in connection with a mastectomy.”
Below are some of the main legal points we want every woman who visits Altiora to understand:
Your Group health plan is probably responsible for coverage of breast reconstruction after your cancer surgery: “WHCRA is binding on group health insurance plans and health insurance issuers providing coverage in connection with a group health plan, which provides medical and surgical benefits for mastectomy.”
No More Claim Denials!
“Such health insurance plans and health insurance issuers are prohibited from rejecting claims for all stages of reconstruction of the breast on which a mastectomy has been performed.”
Breasts Come In Pairs:
The companies must cover the “Surgery and reconstruction of the unaffected breast” to restore your “symmetrical appearance.”
No Dodging Complications:
“The cost of prostheses and physical complications from mastectomy, including lymphedema, must be covered in a manner determined in consultation with the physician and the patient.”
WHCRA Exceptions to the Rules and Rights Pertaining to Breast Reconstruction:
It is true that WHCRA covers most women who have group health plans and individual insurance. However, the Department of Labor explains that the law does not apply to everyone. Here are some instances you need to understand:
1. If your employer is a church, state, or local school district, or a high-risk pool, “your employer may opt out of WHCRA.” The company might have agreed to cover mastectomies. But they were exempted from the breast reconstruction part of the law.
2. Likewise, some health insurance plans might restrict the amount you are allowed to spend on breast reconstruction. They might insist on paying only the “usual, customary and reasonable” rate for surgery in your geographical area.
Investigate Your Insurance Coverage
3. Thus, you need to investigate whether your surgeon will accept the rates dictated by your health insurer. You might also see if you will need to pay the difference to attain the services of the surgeon in whose work you trust the most.
Another point is emphasized at Altiora Plastic Surgery and Medspa. You still have WHCRA if you change insurance companies. What happens to you if you have had a mastectomy, and you later opt for reconstruction? Some women do not realize they are still protected by WHCRA if they change jobs, locations or health insurers.
In other words, “if the new health insurer provides coverage for mastectomies, and you are receiving services relating to the mastectomy, it must cover all stages of your reconstruction procedure…” Likewise, the company must be responsible for “prosthesis and treatment of physical complications from the mastectomy, including lymphedema.”
The Altiora Plastic Surgery and Medspa Take-Away
Of course, in this blog, we cannot cover all the specific points of law. Nor can we advise you about your case. However, we hope you will inform the women of your world that they have options and rights for breast reconstruction after mastectomy.
Knowledge is power. And no woman should have to accept disfigurement because she does not know her options. We will bring you more information next week about medical options for breast reconstruction. Of course, happy BRA Day will be over by that time. But we will still be on our mission to update women about breast cancer surgery and reconstruction options.
The heart of the matter is that such awareness is our mission, not just one for day, but every day.