Does Insurance Cover Voluntary Mastectomy: A Guide to Coverage

Insurance coverage for a voluntary mastectomy can vary depending on the type of surgery and the insurance provider. Some insurance plans may cover the procedure, while others may not.

In the US, the Affordable Care Act (ACA) requires most health insurance plans to cover mastectomies, including voluntary mastectomies, as a preventive service. This means that many people with health insurance will have coverage for a voluntary mastectomy.

However, it's essential to check with your insurance provider to confirm their coverage and any requirements or restrictions that may apply. Some insurance plans may require a letter from a doctor or a specific diagnosis to justify the procedure.

Insurance coverage for a voluntary mastectomy can also depend on the reason for the procedure. For example, some insurance plans may cover a voluntary mastectomy for breast cancer prevention, but not for cosmetic reasons.

Insurance coverage for voluntary mastectomy can be complex, but understanding the basics can help you navigate the process. Many health insurance companies have official policies about covering risk-reducing surgeries for breast and ovarian cancer risk reduction.

Some insurance companies require a second opinion or a letter of medical necessity from your healthcare provider before approving coverage for any surgical procedure. This is a common practice, so be sure to discuss insurance coverage issues with your doctor and insurance company before choosing to have the surgery.

If you have a genetic predisposition to breast cancer, such as the BRCA1 or BRCA2 gene mutations, your insurance company may be more likely to cover a preventative mastectomy. This is because genetic testing has brought these mutations into the light, allowing doctors to address them before the patient ever has to go through breast cancer.

A few conditions that may increase your risk of breast cancer include abnormal cell growth in the breast, a strong family history of breast cancer, and previous radiation therapy to the chest area. These are all valid reasons for considering a preventative mastectomy.

Here are some scenarios where insurance coverage for a preventative mastectomy may be more likely: