Human Resource Blog

Coverage for Reconstructive Breast Surgery in Nevada

	Compensation
Employee Payroll Action Form W-4 Employee Withholding Allowance Cert. Employee Payroll Status/Change Form Direct Deposit Form Total Compensation Summary

	HR Management
Confidential Employee Folder Confidential Employee Medical Folder Job File Worksheet Folder Daily EEO Applicant Flow Log Workplace Information Sheets Request to Inspect Personnel Files

	Labor Laws
Complete State & Federal Labor Law Posters 1 Year Compliance Protection Plan State ONLY Labor Law Posters Federal Labor Law Posters

We have a Nevada employee that needs to have a mastectomy. She is concerned about the insurance coverage for the reconstructive surgery. Our insurance does not cover plastic surgery. Can you tell me anything about the laws regarding reconstructive surgery after a mastectomy?

Yes. In Nevada and in all states across the country, employees that have insurance coverage for a mastectomy also have insurance coverage for reconstructive surgery and related medical procedures that your employee might deal with.

The Women’s Health and Cancer Rights Act (WHCRA) was put into place in 1998 to ensure that women that have to go through a mastectomy can also have the reconstructive surgery covered by their insurance policies, as long as the mastectomy is also covered. In such a circumstance, the reconstructive surgery, while technically it is plastic surgery, is not categorized the same way other plastic surgery might be categorized (such as optional breast augmentation.)

The WHCRA covers the following medical procedures for women with breast cancer:

• Reconstruction of the breast(s) after there has been a mastectomy
• Surgery related to the mastectomy and the reconstruction of the breast in order to give both breasts a symmetrical appearance
• Any necessary artificial enhancements, such as a prostheses
• Complications related to the mastectomy and reconstructive surgery, including lymphedema

Again, as long as your employee has health coverage that allows for a mastectomy, the law requires that the reconstructive surgery is also deductible. Your employee will have to pay all annual deductibles and copayments, as she would for any other medical procedure or doctor’s visit.

Your employee may also be required to stay in a hospital to have the mastectomy and the reconstructive surgery. For such procedures, there is generally a minimum hospital stay that is recommended. The employer and insurance companies are not legally allowed to demands the early release of a patient before this minimum hospital stay unless expressly ordered by a doctor (if the patient is doing better than normal, for example). The Act prohibits employers and insurance companies from bribing or attempting to convince a doctor from releasing a patient early from the hospital after such a medical procedure.  CB