Hospitals would explain reconstruction options to breast cancer patients

Hospitals would give breast cancer patients written notice about reconstruction options, surgeon choice, and available insurance coverage. This covers general hospitals that perform surgery for breast cancer, a breast cancer gene, or another breast abnormality. The notice goes to patients being treated for breast cancer. The notice must explain that patients may consult or seek reconstruction from a plastic surgeon who is board certified or eligible for certification, even outside the hospital or care network. Hospitals would give the notice when they tell patients their diagnosis and before seeking consent for surgery. The requirement would begin on the 90th day after enactment.

Health plans could not use provider network contracts to block or limit recommendations for breast reconstruction surgeons. This covers insurers and state and school employee health plans. It applies to recommendations for reconstruction after treatment or surgery for breast cancer, a breast cancer gene, or another breast abnormality. The recommended surgeon must be board certified or eligible for certification and provide the reconstruction services the patient needs. The treating doctor must put the patient’s medical needs first. The rule would begin on the 90th day after enactment.

Health plans could not deny a request to approve the medical need for breast reconstruction based only on the surgeon’s network status or hospital affiliation. This covers insurers and state and school employee health plans. Covered care includes breast reconstruction and surgery to make breasts more alike after treatment or surgery for breast cancer, a breast cancer gene, or another breast abnormality. The surgeon’s network status or hospital affiliation cannot be the sole reason for denying a request to approve the medical need for reconstruction or related services. The rule would begin on the 90th day after enactment.