S.B. 699 requires specified individual and group insurers that provide coverage for mastectomy to cover reconstruction of the breast on which surgery has been performed, and surgery and reconstruction of the other breast to produce a symmetrical appearance.
Coverage is subject to the same deductibles, co-insurance, and copayment as the mastectomy.
Reimbursement for reconstructive surgery is required only if it is performed under the same policy or plan as the mastectomy. Additionally, with the enactment of H.B. 2219, Louisiana now requires the State Employees' Group Benefits Program to provide coverage for breast cancer screening, effective July 1, 1998. Missouri passed H.B. 129, which requires certain individual and group insurers, including HMOs and other managed health care organizations, that cover mastectomy to also provide coverage for prosthetic devices or reconstructive surgery necessary to restore symmetry resulting from the mastectomy. The law is effective January 1, 1998. Coverage is subject to the same deductible and coinsurance conditions as those applied to mastectomy.