New York to cover chest reconstruction surgery

Good morning and welcome to Monday’s New York Health Care newsletter, where we keep you posted on what’s coming up this week in health care news, and offer a look back at the important news from last week.

New York breast cancer survivors who’ve had a mastectomy or partial mastectomy can soon get chest reconstruction surgery that’s covered by their insurance provider under a new law that’s set to take effect in early 2023.

Gov. Kathy Hochul on Friday signed legislation, NY A8537/NY S7881, that will require insurers to cover both breast reconstruction and chest wall reconstruction surgery after a mastectomy or partial mastectomy beginning Jan. 12, 2023. It also seeks to ensure doctors discuss the option of chest wall reconstruction so patients can make informed decisions.

Insurers were previously required to cover only breast reconstruction surgery, not chest wall reconstruction — with many classifying it as a “cosmetic” procedure, Hochul’s office noted. However, some critics of the legislation have raised concerns that it could add to the cost of health insurance.

Hochul argued that “breast cancer survivors deserve to be treated with dignity and respect by our health care system.” “Women who choose chest wall reconstruction surgery after a mastectomy will now have insurance coverage for the procedure and the necessary information to select this option,” she said in a statement.

Assembly sponsor Stacey Pheffer-Amato said the new law “gives women a choice on how they want their post-mastectomy body to look.” “New York makes history as being the first State in the country to provide women with this coverage,” the Queens Democrat said in a statement. “Our State has taken a tremendous step forward by showing that we don’t just want women with breast cancer to survive, we want to see them thrive.”

… But Eric Linzer, president and CEO of the New York Health Plan Association, argued that “while well-intentioned, mandating coverage of these services is unnecessary and will add to the cost of health insurance.”

“With over 40 mandated benefits in statute, New York requires coverage of more than three dozen types of treatments or services, which increases the cost of health insurance for consumers and employers, particularly small businesses. Adopting new mandated benefits will exacerbate the challenges they face,” he said in a statement. “Affordability is one of the most pressing issues facing health care and we remain focused on working with the Governor and legislative leaders on measures to address health care costs to provide meaningful relief to individuals, families and businesses across the state.”

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