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Passed into law on October 21, 1998 by the federal government, the Women's Health and Cancer Rights Act WHCRA)is one of the amendments to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The WHCRA, a federal law which applies to persons who are covered under group and individual health plans, provides protection for those who choose to have breast reconstruction after a mastectomy. The law does not require health plans to cover the mastectomy procedure, but if the plan does cover the procedure, than it is ultimately required to cover the breast reconstructive surgery, reconstruction on the other breast for symmetrical appearance, and any type of prostheses, such as breast implants. The law also requires insurance coverage for treatment of any complications resulting from the mastectomy, including lymphedema. Insurance providers are required to notify you of this type of coverage at the time you enroll in their plan. And each year, upon renewal, the insurance provider is required to update you on their policy.

Because each patient and each situation is unique, the Women's Health and Cancer Rights Act provides for the appropriate treatment to be determined by the patient and the physician - not the insurance provider. Before WHCRA was passed, mastectomy surgery was being treated as a same day surgery, sending the patient home to care for themselves, sometimes within five to seven hours after surgery. Now, doctors, themselves, can decide when the patient is ready to go home - allowing the patient time to recover both physically and emotionally from the invasive surgery that a mastectomy requires. Also, under the WHCRA, insurance companies are not allowed to deny patients eligibility or continued eligibility to enroll or renew coverage to avoid WHCRA requirements and it also prohibits issuers to provide incentives to or to penalize doctors to cause them to provide care in a manner not supportive with the WHCRA.

In the eight years the Women's Health and Cancer Rights Act has been on the books, I am sure it has been a blessing to many breast cancer patients who have undergone the mastectomy procedure. The law enables women, who are forced to loose one or both breasts because of cancer, to take back their life and be proud of their body. Emotionally, a woman can not feel like a whole woman with only one breast or with no breats at all. This is just a natural, self-conscious feeling that only reconstructive surgery can help. It is so sad that the federal government had to enact a law that insurance providers are required to follow - the reconstruction of a woman's breast should have been an automatic allowance for mastectomy patients.

Even though the federal law requires the coverage of reconstructive surgery for mastectomy patients, individuals are still subject to the normal terms and conditions of their insurance plan, including copays, annual deductibles and coinsurance. Of course, you can find out what these amounts are by contacting your insurance provider. Any questions or concern you may have regarding this extremely complex Women's Health and Cancer Rights Act can be directed to the US Department of Labor (866-487-2365), your health plan provider, or your State Insurance Commissioner's Office.

Learn more about this author, Jill Sznajder.
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