Ore. Senate closes breast cancer coverage loophole

SALEM, Ore. (AP) The Oregon Senate has voted unanimously to close a legal loophole that some health insurance companies had used to decline payment for reconstructive surgery for women with breast cancer.

The change will provide insurance coverage for breast reconstruction, even if only part of the breast is removed, The Register-Guard reported.

Under the federal Women's Health and Cancer Rights Act of 1998, if an insurance plan covers a mastectomy or the complete surgical removal of a breast, usually done for breast cancer patients insurers must also cover the costs of breast reconstructive surgery.

But because both federal and Oregon law refer only to mastectomies, some claims to cover reconstructive work after partial breast removals were occasionally turned down by insurance companies.

Dr. Dann Leonard, a Salem plastic surgeon who specializes in breast reconstructions, said he has seen six or seven cases of insurers denying his patients' claims in the past three years.

Leonard said he typically performs breast reconstructive surgeries on about 50 breast cancer patients a year. Those surgeries can cost $5,000 to $10,000.

Although Leonard said he hasn't collected any statewide numbers, he has heard anecdotal evidence that other doctors were seeing the same periodic denials.

"In the last couple years, it got a lot worse as insurance companies got tighter with their budgets," Leonard said.

He brought the issue to the attention of state lawmakers this session, and state Rep. Val Hoyle, D-Eugene, became the issue's main champion in the Capitol.

Hoyle helped draft House Bill 3616, which clearly defines that mastectomy means "the surgical removal of all or part of a breast or a breast tumor suspected."

Health insurance companies did not oppose the bill that was unanimously approved by the Oregon House last month before the Senate passed it last week. Gov. John Kitzhaber is expected to sign the bill into law this week.
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Information from: The Register-Guard

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