Insurance for bras and breast forms
As you might imagine, we get a lot of questions regarding what happens to a women after mastectomy surgery and what one should do if she choses not to have reconstructive surgery.
As someone who was privileged to testify before the Kansas Legislature for insurance coverage of breast reconstruction, which led to the federal “Women’s Health and Cancer Rights of 1998”, I am amazed at how many women don’t know that federal law requires coverage for post-mastectomy bras, breast forms, and lymphedema treatment. (There are a few exceptions, which I won’t go into here.)
You would not believe what women will do to achieve a symmetrical bust line. It can be as simple as a shoulder pad or fiberfill in the bra, but some women are more creative and use bird seed, beans or something similar that will provide a little weight and more natural “drape” to the breast.
Women come to Santé with a decade old breast form that is taped and glued together; bras that needed replaced in the last century; and items that no longer fit because they have lost 60 pounds or gained 50 pounds.
Though not as prevalent in the newly diagnosed, women who were treated many years ago don’t realize that, for instance, Medicare will cover up to six bras PER YEAR and new breast form(s) (prosthesis) every other year at no charge to the beneficiary. (Coverage requires a physician’s prescription.)
Private insurers may provide different quantities and individuals may have to pay a deductible or co-pay, but they are still entitled to this benefit.
The American Cancer Society sums the Act up in the following way:
The Women's Health and Cancer Rights Act (WHCRA) helps protect many women with breast cancer who choose to have their breast rebuilt (reconstructed) after a mastectomy. It was signed into law on October 21, 1998. The United States Departments of Labor and Health and Human Services oversee this law.
The WHCRA:
• Applies to group health plans for plan years starting on or after October 1, 1998
• Applies to group health plans, health insurance companies, and HMOs, as long as the plan covers medical and surgical costs for mastectomy
Under the WHCRA, mastectomy benefits must cover:
• Reconstruction of the breast that was removed by mastectomy
• Surgery and reconstruction of the other breast to make the breasts look symmetrical or balanced after mastectomy
• Any external breast prostheses (breast forms that fit into your bra) that are needed before or during the reconstruction
• Any physical complications at all stages of mastectomy, including lymphedema
(Sadly, though lymphedema treatment is covered, lymphedema sleeves after treatment or for prevention are not covered by Medicare and many private insurance companies. There is movement afoot to change that. I would encourage you to visit http://lymphedematreatmentact.org/ to learn more. A few voices changed the way insurance companies pay for breast cancer treatment in 1998, we should try and do the same for the women who suffer from lymphedema.)
If you know someone who has experienced a mastectomy and may be unaware of the insurance coverage for bras and breast forms, please share the news. If they don’t have insurance there we can help provide them with resources that may be of help. There is no reason that any women should have to walk around with a bra full of bird seed, unless, of course, she just wants to!
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