March 16, 2000
FOR IMMEDIATE RELEASE
CONTACT: CHRISTOPHER GOETCHEUS
DIVISION OF INSURANCE SAFEGUARDS CANCER PATIENTS' RIGHTS TO BREAST RECONSTRUCTION BENEFITS
(BOSTON, MA) The Division of Insurance has taken steps to encourage Massachusetts insurance carriers to comply with a federal law that requires plans to include certain benefits following a mastectomy. Insurance carriers offering health plans that limit access to any of the federally mandated benefits are being asked to remove any plan provisions, including benefit limits, that are not consistent with the federal requirements.
Last week, ConnectiCare of Massachusetts, Inc., an HMO with a service network concentrated in the Springfield area, agreed to remove a provision in its new products that would have limited the yearly benefit for breast reconstruction prostheses at $300. Under the federal Women's Health and Cancer Rights Act of 1998 (WHCRA), health plans are required to cover breast reconstruction, prostheses and related costs for all physical complications associated with breast reconstruction, including reconstruction of the other breast to produce symmetry.
Although the Massachusetts Legislature is currently considering a bill that would produce a comparable state law, the Division of Insurance is taking steps in advance of any action by the General Court in order to help protect Massachusetts' consumers. The Division can also refer problems to the federal agency charged with enforcement of WHCRA should cooperation be declined. Members and beneficiaries of insured plans who believe they may have been denied benefits can contact the Division's Consumer Services at (617) 521-7777 or the Office of the Managed Care Ombudsman at (800) 436-7757. Members or beneficiaries of self-insured (ERISA) plans should contact the U.S. Department of Labor at (617) 565-9600.