October 18, 2017
OLYMPIA, Wash. – Nearly 6,000 women in Washington state are expected to be diagnosed with breast cancer this year. Unfortunately, too many women are unsure of their rights to rebuild their breasts, should they need a mastectomy.
Gov. Jay Inslee and Insurance Commissioner Mike Kreidler, along with the Washington Health Care Authority, and the Washington Department of Health are joining forces to help educate women and men of their rights after a mastectomy.
“Trudi and I urge all women and men to learn about their rights and options around breast reconstruction,” Gov. Jay Inslee said. “Patients should make the decision that is right for them, but insurance coverage should be the least of their worries during this time.”
“Most insurance companies that cover mastectomies also must cover your reconstructive surgery,” Kreidler said. “This is a personal decision that’s yours to make. Even if you delay your decision, you’re still covered.”
Under state and federal law, if your insurance plan covers mastectomies, it must also cover services related to the mastectomy, including:
All states of reconstruction of the breast on which the mastectomy has been performed;
Surgery and reconstruction of the other breast to produce a symmetrical or balanced appearance;
Any external prostheses that fit into your bra before or during the reconstruction;
Treatment of physical complications of all states of the mastectomy, including lymphedema or fluid build-up in the arm or chest; and
Any medically necessary hospitalization for treatment.
Coverage for mastectomies and related services are covered by all state-regulated plans, Apple Health (Medicaid), and Medicare. Most self-funded health plans also provide coverage, but if they choose not to, they must request an exemption from the federal government (www.cms.gov)
Senate Bill 5481 (leg.wa.gov), sponsored by Senator Annette Cleveland (D-49th District), was signed into law earlier this year and directed the state agencies to create an education campaign. The partner agencies launched a social media campaign today, using the hashtags #BRAday and #breastreconstruction.