What are my rights with respect to mastectomy and breast reconstruction services?
Both the New York Insurance Law and the federal Women’s Health and Cancer Rights Act (WHCRA) require that we cover specific services in connection with a mastectomy, subject to applicable referral and/or cost-sharing (copayment, deductible, coinsurance) requirements of your health benefits plan. WHCRA, which was enacted after the New York law, added a requirement that we specifically identify prostheses as a covered benefit in connection with mastectomy. Some of our older (pre-WHCRA) contracts/certificates did not specifically mention prostheses as covered. However, we have been covering prostheses, along with the required breast reconstruction and care of physical complications, since the New York mandate was effective. If your member contract/certificate or rider did not specify that prostheses are covered in connection with mastectomy, and you or your provider either did not submit claims or received a claims denial for the prostheses, please contact Customer Service at the phone nu
