When breast cancer requires a mastectomy, the WHCRA provides the patient with certain protections. There is a guarantee that follow-up procedures involving breast reconstruction and anything else reasonably related to the mastectomy will be covered by the insurance provider.

How Do I Know If I Am Protected under the WHCRA?

If you are with a group health plan or insurance/HMO policy that offers mastectomy coverage, the WHCRA requires that the provider also offer coverage for certain services relating to the mastectomy procedure in a manner determined by consultation between a physician and the patient.

What Procedures Are Covered under the WHCRA?

If you are protected under the WHCRA, your provider must cover any procedures that involve the following:

  • Reconstruction of the breast on which the mastectomy was performed
  • Reconstruction on the other breast to produce a symmetrical appearance
  • Prostheses
  • Treatment for any and all physical complications at all stages of the mastectomy, including lymphedemas

Seeking Legal Help

Be sure to complain to the insurance provider and find out exactly why they are denying you coverage of those related procedures. If you cannot resolve the dispute by yourself, your best solution is to contact an insurance  attorney who has experience in dealing with insurance policy disputes and even civil rights. You may be entitled to money damages if your insurance provider has violated the WHCRA, and you can be compensated for any procedures you were supposed to be covered for. Your lawyer can advise you of your rights and what course of action to take in protecting your rights.