Will my insurance cover DIEP flap reconstruction?

Since the passage of the federal Women's Health and Cancer Rights Act of 1998, insurance companies have been required to cover breast reconstruction if they cover mastectomies. In addition, many state legislatures have passed laws that clarify what must be covered within their particular states; you can read brief summaries of the laws in New York and New Jersey (as well as other states) here.

In general, when insurance covers breast reconstruction, it must cover all types, including DIEP flap surgery. A patient and her physician must decide together what the best option is; however, many insurance carriers are not as familiar with DIEP flap surgery and may require extra information and pre-authorization steps.

Even if you have an HMO (no out-of-network benefits), you may still be able to see a DIEP flap surgeon of your choice, because there are few experienced microsurgeons that perform DIEP flap reconstruction -- and since patients have a right to this type of reconstruction, HMOs often must look outside of their network for qualified surgeons.

Our office is experienced in helping patients navigate insurance issues, so please call if you have any concerns or questions.

Dr. Redstone is the founder of the Microsurgical Breast Reconstruction Program at St. Barnabas Medical Center and has offices in West Orange, New Jersey and in New York City. For more information on DIEP flap reconstruction, as well as other reconstructive procedures, please call us at 212.249.1500 (New York) or 973.867.8388 (New Jersey).