Many health insurance companies have official policies about whether and under what conditions they will pay for prophylactic mastectomy (bilateral or contralateral) and bilateral prophylactic salpingo-oophorectomy for breast and ovarian cancer risk reduction. However, the criteria used for considering these procedures as medically necessary may vary among insurance companies. Some insurance companies may require a second opinion or a letter of medical necessity from the health care provider before they will approve coverage of any surgical procedure. A woman who is considering prophylactic surgery to reduce her risk of breast and/or ovarian cancer should discuss insurance coverage issues with her doctor and insurance company before choosing to have the surgery.
The Women’s Health and Cancer Rights Act (WHCRA), enacted in 1999, requires most health plans that offer mastectomy coverage to also pay for breast reconstruction surgery after mastectomy. More information about WHCRA can be found through the Department of Labor.