Breast Reconstruction Covered by Insurance & Cost

Is Breast Reconstruction Covered by Insurance?

If you’ve had one or two breasts removed from a mastectomy to treat or prevent breast cancer, breast reconstruction surgery is the process that restores and reshapes your breasts. While navigating the emotional and physical recovery process, you shouldn’t have to worry about the costs of the procedure, nor how much is covered by insurance.

At New York Breast Surgery Center, you learn the full scope of your coverage and how much you’re responsible for before undergoing any procedure. The bona fide plastic surgeon, Dr. David Shokrian and his board-certified colleague, Dr. Mohamed Soliman Ahmed Elfar perform breast reconstruction following your mastectomy. While they aren’t in-network with any insurance companies, the experienced staff at the Center find out what type of out-of-network coverage you’re entitled to with your health insurance.

What Type of Breast Reconstruction Does Insurance Typically Cover?

Insurance typically covers implant-based and autologous tissue flaps reconstructive surgeries following a mastectomy. The insurance is obliged to cover additional procedures done on the opposite breast to achieve symmetry.

In 1998, Congress passed the Women’s Health and Cancer Rights Act (WHCRA), which obliges group health plans covering women who need mastectomies — or those diagnosed with breast cancer — to cover breast reconstruction as well. Besides reconstructive surgeries, some insurance providers cover follow-up breast revision reconstructive surgeries to address changes in your reconstructed breasts.

“At New York Breast Surgery Center,” adds Dr. Shokrian, “Dr. Elfar and I work closely with you so you understand what’s covered by your insurance company and what additional out-of-pocket expenses that you may incur from the surgery. Then we find ways for you to afford the best care.”

Does Insurance Cover Additional Procedures after Breast Reconstruction?

Besides figuring out the pre-calculated costs, the surgical team at New York Breast Surgery Center may discover the need for or recommend additional corrective surgeries during your consultation. Any additional procedure may increase your cost. Their top-rated plastic breast surgeons in New York City perform a full examination, discuss your goals and explain what plastic surgery can and can’t do before recommending any additional procedure. For example:

• Your reconstructed breast plan may not initially include the nipple-areola complex. Dr. Shokrian may recommend a minor outpatient procedure to reconstruct your nipple, which most women say is the final touch to feeling like their old selves again.
• Your New York plastic surgeon may recommend correcting the nipple and possibly reducing the areola on your other breast for aesthetic purposes.
• If your breasts appear asymmetrical after a reconstruction procedure, your surgeon may recommend an additional procedure to address the asymmetry.

“We care deeply about what you want to achieve with a breast reconstruction surgery,” says Dr. Shokrian. “Once you visit our office in either Midtown Manhattan or Great Neck, Long Island for a consultation, we want you to freely discuss your concerns. We want to know you and the reasons you’re seeking breast revision surgery after breast reconstruction. That helps us design a treatment plan to help you achieve your specific goals. If it helps, keep a diary of the changes you’ve noticed lately so we can address your concerns properly.”

Do Health Insurance Plans Cover Breast Reconstruction?

Although the WHCRA mandates insurance coverage for breast reconstruction, some government health plans may be exempt from the federal coverage requirements. These include:

• Medicare. If your plastic surgeon in Midtown Manhattan or Long Island decides that the procedure is deemed medically necessary, Medicare covers the cost of your breast reconstructive surgery, but only after you finish certain breast cancer treatments. If you have Medicare, your surgery team supplies the detailed documentation required to show that the procedure is medically necessary.
• Medicaid. Medicaid coverage varies by state. Although Medicaid generally covers breast reconstruction if it’s deemed medically necessary, check your state rules and prior authorization requirements at your local Medicaid office. If you qualify for Medicaid through the Breast and Cervical Treatment Program, breast reconstruction is covered as a standard part of your treatment plan.

To cut some of the guesswork, check with your insurance provider prior to scheduling your breast reconstruction consultation at New York Breast Surgery Center. During your consultation, your surgical team explains the out-of-pocket expenses you may incur from the surgery and offers an itemized breast procedure treatment plan with no hidden costs. You also receive guidance on how the billing of breast reconstruction works.

What Factors Influence the Cost of Breast Reconstruction?

Your breast reconstruction surgery conforms to your specific goals. Breast reconstruction at New York Breast Surgery Center charges only for what you need, your surgical plan and other factors that include:

• Surgeon’s fees. The cost of your surgeon’s services significantly impacts the cost of your breast reconstruction. Board-certified plastic surgeons like Dr. Elfar and experienced plastic surgeons like Dr. Shokrian have higher surgical fees than general cosmetic providers due to their vast and direct experience in surgical breast procedures. And higher upfront costs mean fewer complications and better post-operative care.
• Anesthesia fees. Depending on your procedure’s complexity and your pain tolerance, your NYC expert offers both general and local anesthesia, as well as IV sedation. General anesthesia is administered by a certified anesthesiologist, which increases your overall cost, but is vital to your safety. Since the dosage and type of anesthesia vary, the surgery team excludes this cost from your initially estimated quote. It’s calculated after your consultation. When your procedure is covered, the anesthesia usually is too.
• Surgical technique. For breast reconstruction surgery, your NYC plastic surgeon may recommend implant-based reconstruction or autologous flap reconstruction. Implant-based reconstruction uses tissue expanders and implants, which are generally cheaper compared to flap reconstruction. Flap reconstruction uses your own fat tissue, is more complex, takes longer and uses more advanced techniques for a natural-feeling breast. Your surgeon determines which technique to use with your input.

Dr. Shokrian adds, “At New York Breast Surgery Center, we understand the anxiety and uncertainty you feel about breast reconstruction. As breast reconstruction experts, we’re committed to addressing your concerns and making sure you receive all the benefits you’re entitled to after undergoing a mastectomy. Though out-of-network, we offer a range of breast reconstruction procedures, and our staff does everything possible to relieve you from the financial stress of your care.”

Dr. Shokrian and Dr. Elfar understand the significance of your life-changing decision to have breast reconstruction. They take the time to fully understand your unique concerns and goals. These top-rated plastic surgeons foster trust by listening to you and dedicating their time, resources and expertise to you, regardless of your insurance status. The two surgeons work well together, but offer individual strengths:

• Mohammed Elfar — a board-certified plastic surgeon with over three decades of experience in reconstructive surgeries —uses the most advanced techniques when performing breast reconstruction, while promoting your emotional well-being.
• David Shokrian is a talented plastic surgeon with almost two decades of experience. Dr. Shokrian’s expertise in body sculpting and breast procedures, his surgical techniques and commitment to natural-looking results have made him a trusted choice for men and women.

Can I Still Afford Breast Reconstruction Surgery with an Out-Of-Network Provider?

“Though we’re still out-of-network,” says Dr. Shokrian, Dr. Elfar and I, as well as our staff, work with you to find with the best possible financial outcome. In the long run, we find that our patients often save money because of the exceptional results they get, with fewer complications and fewer needed revisions.”

New York Breast Surgery Center is committed to patient advocacy by allowing every woman to choose her own breast reconstruction journey and by achieving the best possible aesthetic outcomes. If you’ve recently had a mastectomy and are seeking a plastic surgeon who’ll promote your physical and emotional well-being, schedule a consultation for a breast reconstruction in Midtown Manhattan or Great Neck, Long Island today.

Home → Cost & Financing → Breast Reconstruction Covered by Insurance & Cost