Insurance Coverage for AFC
What’s in the Bill? New York State law contains a word for word copy of the federal Women’s Health & Cancer Rights Act (WHCRA) which requires most insurance companies to cover the costs of breast reconstruction. Wherever the law says “breast reconstruction”, Bill A8537 (Pheffer Amato) / S7881 (Stavisky) simply amends it to say “breast or chest wall reconstruction.” It’s that simple! The bill also mentions aesthetic flat closure as defined by the National Cancer Institute as specifically included in “chest wall reconstruction.” This will ensure that patients are not denied necessary care simply because they chose to forgo breast reconstruction in favor of a flat closure.
UPDATE (May 03, 2022) – The bill has passed in the Assembly! On to the Senate!
UPDATE (Feb 2022) – The American Society of Plastic Surgeons (ASPS) supports the bill!
What Supporters Are Saying
It makes no sense at all for insurance to cover the much more costly breast reconstruction and not cover chest wall reconstruction surgery.S.L.
Everyone who needs a mastectomy should be able to chose a safe aesthetic flat closure, covered by health insurance. No one should have to fight with an insurance company to receive necessary care.S.D.
It’s the right thing to do and corrects an important oversight in the initial law.E.T.
Patients should not be denied necessary care simply because they chose to forgo breast reconstruction in favor of a flat closureT.T.
Because women must have the right and ability to maintain/regain their self-esteem after losing a part of their body that so identifies them as a woman. A cancer diagnosis is bad enough without having to go through the rest of their lives looking mauled.P.A.
Every woman deserves an aesthetic flat closure. Not every woman wants implants OR reconstruction. But just because we are declining reconstruction, doesn’t mean we don’t want or deserve an aesthetically acceptable result. It’s important for our emotional and mental well being. If reconstruction is covered under insurance then an aesthetic flat closure needs to be covered as well.L.S.
Frequently Asked Questions (FAQ)
The law does not mention chest wall reconstruction – i.e., aesthetic flat closure (NCI), the creation of a smooth, flat chest for patients who choose not to reconstruct their breasts. All patients deserve a surgical outcome that reflects their reconstructive choice with dignity. But that’s not what many patients going flat get, because it’s not clear that insurance has to cover aesthetic surgical services for patients going flat. The law’s specific wording just needs to be “tweaked” a bit to solve this.
We simply want to add the phrase “or chest wall” to the three places where the law mentions “breast reconstruction,” and specify that aesthetic flat closure is included in “chest wall reconstruction.”
Right now, women are routinely denied insurance coverage for aesthetic flat closure surgery – at their initial surgery, for revision (“clean-up” surgery), and at explant (breast implant removal). About 1 in 4 women going flat receive an egregiously poor aesthetic result, and those who are denied coverage and can’t afford to pay thousands of dollars out of pocket are forced to live with that. It’s an avoidable trauma that can be prevented with a simple amendment to the law.
The result of this amendment – mandated insurance coverage for chest wall reconstruction – will be that women going flat in New York State will be able to access aesthetic surgical services just like their sisters who choose to reconstruct their breasts. More patients will be able to have a plastic surgeon at their initial surgery… and if they do get a poor aesthetic outcome initially, they will be able to get it fixed. Patient autonomy will be better supported, and outcomes will improve. Patients seeking aesthetic flat closure after explanting their breast implant reconstruction also won’t have to fight their insurance companies in order to get an aesthetic outcome they can live with.
In this setting, it is reconstruction (surgical restoration or shaping) of the breastless chest wall contour after mastectomy – also called aesthetic flat closure. (More)
“Breast reconstruction” is defined as surgery to rebuild the shape of the breast after a mastectomy. (NCI) That’s why it is often interpreted to exclude aesthetic flat closure – because the anatomic contour being restored with AFC is not a “breast” – it’s the chest wall. Hence, the need for the addition of “chest wall” into the law.
Breast reconstruction, sometimes referred to as breast mound reconstruction, restores the shape of the breast that was removed at the time of the mastectomy. Aesthetic flat closure, also called chest wall reconstruction, restores the shape of the (flat, breast-less) chest wall contour rather than the breast.
We anticipate cancer surgeons in New York State will have an easier time getting fairly reimbursed for their time spent in the operating room contouring their patients’ chest walls at their initial mastectomy. Ultimately, we also expect to see more widespread funding for and utilization of oncoplastic training in aesthetic flat closure techniques, both for general and breast surgeons.
We anticipate it becoming more common for plastic & reconstructive surgeons to be present at patients’ initial mastectomy surgeries in order to produce an aesthetic flat closure at that time. We expect more patients who have forgone conventional breast reconstruction to seek out revision surgery with plastic & reconstructive surgeons in order to improve the contour of their chest wall when they become aware that this is an accessible option.
And we expect other states, and ultimately the federal law, to enact similar amendments. New York State is leading the way!
We anticipate that more mastectomy patients will choose aesthetic flat closure as it becomes offered as a valid and aesthetically pleasing reconstruction choice alongside conventional breast reconstruction. This amendment will directly support that trend because it will improve reimbursement for surgeons providing aesthetic flat closure services.
We do expect there will be some outlay to pay for aesthetic surgery for the patient population going flat because this amendment corrects a historic disparity in access to this type of care. However, because the cost of any type of aesthetic flat closure procedure pales in comparison to the cost of any type of conventional breast reconstruction, on the balance we anticipate cost savings for insurance companies.
Please contact us so that we can learn how we can best support each other! Our Council of International Advocates includes members from across the globe, and we participate in other global initiatives to promote aesthetic flat closure. We welcome any and all discussion about how to constructively use gains and lessons from US advocacy to other nations so that ALL mastectomy patients can access an optimal standard of surgical care!
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