Help appealing denials for breast reconstruction after mastectomy.

Appeal Your Breast Reconstruction Denial

Federal law protects your right to breast reconstruction after cancer surgery.

Understanding Your Breast Reconstruction Denial

Breast reconstruction after mastectomy is protected by the Women's Health and Cancer Rights Act (WHCRA), which requires group health plans that cover mastectomy to also cover reconstruction. Despite this federal protection, insurance companies still deny reconstruction procedures, second breast procedures for symmetry, and associated services. You have legal rights to this coverage.

Common Reasons for Denial

! Procedure deemed cosmetic
! Symmetry procedure not covered
! Type of reconstruction not approved
! Out-of-network surgeon
! Prior authorization requirements
! Revision surgery denied
! Nipple reconstruction denied

How We Help

We help you cite the Women's Health and Cancer Rights Act and document that your reconstruction is a federally protected benefit that your insurer must cover.

Start your breast reconstruction appeal — it takes about 3 minutes.

Some Types of Evidence We Can Use For Supporting Your Appeal

✓ The Women's Health and Cancer Rights Act requires insurance coverage of breast reconstruction after mastectomy.

✓ Breast reconstruction improves quality of life and psychological well-being after cancer surgery.

✓ WHCRA mandates coverage for symmetry procedures on the contralateral breast.

✓ Denying federally mandated breast reconstruction coverage violates federal law.

Financial Assistance Directory

Curated copay foundations, manufacturer programs, and safety-net clinics that may help with the cost while you appeal.

For your condition

CancerCare Co-Payment Assistance Foundation (opens in a new tab)

Copay assistance for chemotherapy and targeted therapies for specific cancer diagnoses. Funds open/close by cancer type.

General copay foundations & directories

NeedyMeds (opens in a new tab)

Searchable database of 5,000+ patient assistance, copay, and diagnosis-specific programs. Start here if you are not sure where to look.

Eligibility: No eligibility check - the directory itself is free. Individual programs have their own income and insurance criteria.

Patient Advocate Foundation Co-Pay Relief (opens in a new tab)

Direct copay assistance for insured patients with chronic, life-threatening, or rare conditions. Covers many disease funds.

Eligibility: Generally requires insurance coverage and income up to 400% of the federal poverty level (varies by fund).

Phone: 1-866-512-3861

HealthWell Foundation (opens in a new tab)

Independent charity providing copay, premium, and travel assistance grants across 70+ disease funds.

Eligibility: Must have insurance covering the prescribed treatment; income thresholds vary by fund. Funds open and close as donations allow.

The Assistance Fund (TAF) (opens in a new tab)

Copay, insurance premium, and travel assistance for patients with chronic and rare diseases.

Eligibility: Must have insurance and meet income limits (typically up to 500% FPL, fund-dependent).

Good Days (opens in a new tab)

Copay assistance and other support for chronic-disease patients.

Eligibility: Funds vary by disease and open/close based on availability. Usually requires insurance and income under ~500% FPL.

PAN Foundation (Patient Access Network) (opens in a new tab)

Disease-specific copay assistance funds for ~70 conditions. Funds open and close throughout the year - check the website or sign up for fund-open alerts.

Eligibility: Insurance required; income limits typically 400-500% of FPL depending on the fund.

NORD (National Organization for Rare Disorders) (opens in a new tab)

Patient assistance, copay, and travel programs for people living with rare diseases.

RxAssist Patient Assistance Program Center (opens in a new tab)

Comprehensive directory of manufacturer patient assistance programs. Search by medication to find the manufacturer's free-drug program if you are uninsured or under-insured.

Safety-net clinics & 340B

HRSA Find a Health Center (FQHC locator) (opens in a new tab)

Federally Qualified Health Centers (FQHCs) provide primary care on a sliding-fee scale and dispense many medications at 340B-discounted prices, regardless of insurance status. Often the cheapest path for uninsured or under-insured patients.

HRSA 340B Program (provider directory + program info) (opens in a new tab)

Background on the 340B Drug Pricing Program. Use to verify whether a particular clinic or hospital is a covered entity before assuming discounted pricing applies.

State Pharmaceutical Assistance Program (SPAP) directory (opens in a new tab)

State-run programs (mostly for seniors and people with disabilities) that supplement Medicare Part D and reduce prescription costs. Availability and benefits vary by state.

Medicaid eligibility & application (Healthcare.gov) (opens in a new tab)

If denied insurance is unaffordable, check Medicaid / CHIP eligibility - thresholds and pathways vary by state, and many expansion states cover adults up to 138% FPL.

Program eligibility, fund availability, and contact info change frequently. Verify with each organization before assuming a program is open.

Patient Advocacy & Support Organizations

These organizations provide education, support, and advocacy for patients:

National Breast Cancer Coalition

Grassroots advocacy organization dedicated to ending breast cancer through research and policy.

Susan G. Komen

Leading breast cancer organization funding research and providing patient support.

Frequently Asked Questions

WHCRA requires coverage of: reconstruction of the breast on which mastectomy was performed, surgery on the other breast for symmetry, prostheses, and treatment of physical complications at all stages of mastectomy including lymphedema.

WHCRA requires coverage of 'reconstruction of the breast' without specifying type. Your appeal can argue that the reconstruction method chosen by you and your surgeon should be covered.

Yes. Nipple reconstruction is considered part of breast reconstruction under WHCRA. If denied, your appeal should cite this federal requirement.

Ready to Fight Your Breast Reconstruction Denial?

Our free AI-powered tool will help you generate a compelling appeal letter in minutes.

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Disclaimer: Fight Health Insurance is not affiliated with, endorsed by, or partnered with any pharmaceutical manufacturer, healthcare provider, medical device company, or patient assistance program. All information provided is for educational and informational purposes only and does not constitute medical or legal advice. Please consult with your healthcare provider regarding treatment options and with your insurance company regarding coverage decisions.