Since there are literally thousands of different insurance policies out there, it is impossible for us to state definitively what your insurance would cover. However, if your insurance would cover other types of breast reconstruction, such as TRAM flaps or implants, then it should cover DIEP / SIEA flaps. Because DIEP / SIEA flaps are relatively new, we often must educate the insurance companies about these flaps but we are very familiar with doing this.

If you are on a managed care plan (particularly HMOs), then you may be restricted as to which physicians you can see. Since there are so few physicians in the country that do DIEP / SIEA flaps, it is possible that your insurance plan will not have a physician on it that can do the DIEP or SIEA. If that is the case, be aware that you have the option of appealing this with your insurance company. You can tell them that you need a procedure done and no physician on the plan can do it. Most plans have provisions which allow you to go "out-of-network" in order to get a procedure done, without any financial penalty, in these types of cases. If you need help in doing this, we will be happy to assist you.

If you have any questions about how your insurance would work with a DIEP flap, please feel free to call our office.

Here in Texas (as well as some other states) there is a State Law regarding insurance coverage of breast reconstruction following a mastectomy.

For the text or an Analysis Summary of the Texas law (HB 262, 75th Legislative Session), you can click here.