The Women’s Health and Cancer Rights Act of 1998 (WHCRA) was designed and enacted to legally protect the right to breast reconstruction. The law remains in place, however, a rapidly evolving healthcare landscape has illuminated some limitations within its protections. Read on for some key facts and common questions on exactly what the law aims to protect, who it’s for, where it sometimes falls short, and how you can use it as a tool of self-advocacy.
The WHCRA covers breast reconstruction at any point after mastectomy.
The law states that health insurance companies are compelled to cover all stages of breast reconstruction without limit. This means that patients who undergo medically necessary mastectomies may choose to have breast reconstruction at any point after their mastectomy, even months or years later. It also means that patients may choose to have revision procedures at any point after mastectomy.
Who does the WHCRA protect?
While the name of the law uses the word “women,” the law itself does not specify a gender identity. It applies to anyone of any gender, provided that their mastectomies were medically necessary.
What types of procedures does it include?
The law states that it protects all stages of a breast reconstruction on which a mastectomy has been performed, along with all prostheses and treatment for complications of mastectomy (like lymphedema). It also compels coverage for symmetry procedures on the opposite breast (in patients who have a unilateral mastectomy).
Where does the law fall short?
The WHCRA has limitations. State-level exemptions exist. However, one of its most pernicious shortcomings is in its failure to compel insurance companies to pay reconstructive surgeons a fair or appropriate rate. An increasing number of plastic surgeons are no longer willing to perform breast reconstruction, because their costs are so severely undercut by poor rates established by health insurance companies. While this is largely a provider-side issue, it deeply impacts patients, who may have additional issues finding the right care. It is also important to know this when interviewing plastic surgeons. If they wish to work outside of health insurance, know that that is their choice. It is not your only option as a patient.
How can patients use the WHCRA as a tool for self-advocacy?
The WHCRA can be a powerful tool in compelling insurance companies to continue to cover breast reconstruction procedures when patients invoke it themselves. Insurance companies may deny claims that are protected under the law. Patients should not be afraid to appeal those claims and remind insurance providers that they and their surgeons are the only people who get to decide when a breast reconstruction is complete. Insurance experts encourage patients to request appeals and to self-advocate at the highest level in every setting. Patients have even reached out to their congressional representatives to report ignorance or misuse of the law.
To learn more about the WHCRA, click here.
