Insurance & Billing

Reconstructive and medically necessary procedures may be covered where documented medical need exists. Breast reduction is the most common example — where symptoms are documented, many carriers provide coverage subject to their own criteria.

Federal protection for breast reconstruction

Under the Women’s Health and Cancer Rights Act (WHCRA), most insurance plans that cover mastectomy must also cover breast reconstruction, surgery on the opposite breast to achieve symmetry, and treatment of related complications.

Additional charges

Surgery may involve separate billing for facility fees, anesthesia, pathology, and implants or devices. These are billed separately from the surgeon’s fee.

Surprise billing protections

Under the federal No Surprises Act, you are protected from balance billing in certain circumstances, including emergency services and services from out-of-network providers at in-network facilities. More at cms.gov/nosurprises.

Our office provides clear cost information before surgery and will help you understand what your plan covers. Questions are welcome — clarity beforehand prevents unwelcome surprises afterwards.