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State and insurance provider reach mastectomy deal

Thursday, May 1, 2014
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— Patients who see out-of-network plastic surgeons for breast reconstruction will be covered under an agreement reached between the state and insurance provider Empire Blue Cross Blue Shield.

Attorney General Eric Schneiderman says Thursday that Empire members who undergo the surgery following a mastectomy will be covered if an in-network surgeon isn't available at the hospital where the surgery is done.

New York and federal law requires plans to cover post-mastectomy breast reconstruction as determined by the physician and patient.

Empire had denied some patients out-of-network exceptions, resulting in some patients having to go to different hospitals where the specialists were in-network.

Empire did not initially return calls seeking comment.

 
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