Since there are literally thousands of different insurance policies out there, it is impossible for us to state definitively what amount your insurance would cover. However, here in Texas (as well as some other states) there is a State Law which mandates insurance coverage of breast reconstruction following a mastectomy. There is also a related federal law. However, mandating coverage does not mean 100% coverage. You still must comply with your insurance requirements.
Our surgeons accept Medicare and participate with many managed care plans.
Some managed care plans, particularly HMOs, restrict which physicians you can see. In some cases if you go outside of the “network” of physicians your coverage may be less (deductible higher, etc) or even in some cases there may be no coverage at all if you go out of the “network”. However, you should be aware that if you are considering one of the perforator flap procedures, such as the DIEP, you may have alternatives. Because there are so few physicians in the country that do DIEP/SIEA flaps it is possible that your insurance plan will not have a physician in the “network” that can do the DIEP or SIEA. If that is the case, be aware that you have the option of appealing this with your insurance company. You can tell them that you need a procedure done and that no physician on the plan’s “network” can do it. Most plans have provisions which allow you to go “out of network” in order to get a procedure done, usually without any financial penalty, in these types of cases. If you need help in doing this, we will be happy to assist you.