Women’s Health and Cancer Rights Act met
The Federal law
The Women’s Health and Cancer Rights Act (WHCRA) helps protect many women with breast cancer who choose to have their breasts rebuilt (reconstructed) after a mastectomy. This federal law requires most group insurance plans that cover mastectomies to also cover breast reconstruction. It was signed into law on October 21, 1998. The United States Departments of Labor and Health and Human Services oversee this law.
- Applies to group health plans for plan years starting on or after October 1, 1998
- Applies to group health plans, health insurance companies, and HMOs, as long as the plan covers medical and surgical costs for mastectomy
Under the WHCRA, mastectomy benefits must cover:
- Reconstruction of the breast that was removed by mastectomy
- Surgery and reconstruction of the other breast to make the breasts look symmetrical or balanced after mastectomy
- Any external breast prostheses (breast forms that fit into your bra) that are needed before or during the reconstruction
- Any physical complications at all stages of mastectomy, including lymphedema
Mastectomy benefits may have a yearly deductible and may require that you pay co-insurance. Co-insurance is when health costs are insured for less than the full amount and the patient must pay the difference.
For instance, the company may cover 80% of your expenses after you pay the deductible, leaving you to pay the other 20%. This 20% is also called a co-payment or co-pay. But any required deductible and co-insurance must be like those the plan uses for other conditions it covers. So, if a plan pays 80% for hospital and surgery fees for an appendectomy, but only 70% of hospital and surgery fees for breast reconstruction, that would violate the WHCRA.
The Law For Young Women
Breast cancer is extremely rare in young women. But when it does happen, it can be serious, even deadly. A little-noticed section in the health-care overhaul aims to raise awareness among young women and their doctors about the risk of breast cancer between the ages of 15 and 44.
The law directs the Centers for Disease Control and Prevention to create education campaigns that will focus on breast cancer and young women, and encourage healthful habits that promote prevention and early detection of the disease.
The law also provides grants to groups that support young women with breast cancer. And it directs the National Institutes of Health to develop new screening tests and other methods to prevent breast cancer in young women and improve early detection.
Some survivors experience employment discrimination when they return to work or apply for a new job after diagnosis. Knowing about your rights and responsibilities in the workplace can help you with discrimination problems.
A health insurance company’s decision about insurance coverage for breast cancer treatment and services is often based on the cost of the service, rather than on what the patient’s doctor prescribes as medically appropriate and necessary. Most health insurance companies are businesses committed to their own interests. You must be equally prepared to represent and protect your interests.
Job security. That’s what often springs to mind for recently diagnosed cancer patients when they consider how their disease might impact their employment status. They worry, “How will this affect my job? Will I be able to keep it?” The answer, in most cases, is that you cannot lose your job just because you have cancer.
The provisions Health Insurance Portability and Accountability Act (HIPAA) of 1996 are in place, and other changes are being instituted by The Consolidated Omnibus Budget Reconciliation Act (COBRA), The Genetic Information Nondiscrimination Act (GINA), and The Patient Protection and Affordable Care Act (PPACA) what can you expect in terms of privacy and insurance aid related to your cancer diagnosis and treatment?
The American Bar Association (ABA) recently released an op-ed piece authored by the organization’s President, Carolyn Lamm, focusing on the challenges faced by breast cancer patients. One area discussed is workplace rights. The article identifies employment issues as one of the primary concerns of patients as they schedule time for treatment and recovery.