Several Laws Affect Breast Cancer and Patients
22OctWomen’s Health & Cancer Rights Act (WHCRA)
The Women’s Health and Cancer Rights Act (WHCRA) is a federal law that provides certain rights and protections to patients who choose to have breast reconstruction after a mastectomy. This law requires most health insurance plans that cover mastectomies also to cover breast reconstruction, prostheses and physical complications of all stages of mastectomy, including lymphedema. This includes coverage for all stages of breast reconstruction, surgery and reconstruction of the other breast, prostheses, and treatment of physical complications.
Despite the title, WHCRA benefits are not limited to cancer patients. People who have risk-reducing, prophylactic mastectomies are also entitled to WHCRA benefits as long as the health insurer covers the mastectomy. Also, nothing in the law limits WHCRA benefits to women. Men are covered by the law too.
WHCRA does not require group health plans or health insurance companies to cover mastectomies, however, if the plan does cover this surgery, then it is generally required to abide by the WHCRA. Many states have laws that provide additional protections. Ask your surgeon or check with your state insurance department to learn if you have a right to additional mastectomy-related benefits.
Note that the WHRCA does not require 100% coverage by health insurance so copays, coinsurance and deductibles often apply.
Exceptions
Certain health plans, such as self-funded, short-term, or government health plans, as well as those sponsored by religious organizations, are exempt from the WHCRA (Women’s Health and Cancer Rights Act). Additionally, Medicare and Medicaid are not subject to the law’s requirements as they follow their own regulations.
Breast and Cervical Cancer Treatment Act
This law ensures that low-income, uninsured women diagnosed with breast or cervical cancer through the CDC’s National Breast and Cervical Cancer Early Detection Program receive the necessary treatment.
Access to Cancer Therapies Act
This act provided temporary coverage for specific cancer drugs between 2004 and 2006, after which Medicare beneficiaries gained access to a prescription drug benefit.
ADA (Americans with Disabilities Act)
Under the ADA, cancer is recognized as a disability if it, or its side effects, significantly limits a person’s major life activities. Additionally, individuals may be entitled to a minimum hospital stay as mandated by state law, provided their employer’s group health plan includes coverage through an insurance company.