State Advocacy
Strengthening Breast Reconstruction Coverage
ASPS is leading a nationwide effort to modernize breast reconstruction coverage through the Advancing Women's Health Coverage Act and new or stronger state coverage laws. This legislation will ensure that every patient can access the full range of reconstructive options after treatment for breast cancer – whether advanced microsurgical or implant-based – regardless of where they live or what type of insurance they have.
State legislation plays a role in addressing gaps in access and can often apply to many health insurance plans that may not be fully covered by WHCRA or the Advancing Women's Health Coverage Act (AWHCA) – especially when insurers restrict payment, exclude complex procedures or fail to maintain adequate networks. Modernized state laws empower patients – not profit-driven health insurance companies – to choose the reconstruction option that is best for their health and quality of life.
Despite having a clear federal law requiring the opposite, health insurance companies frequently deny coverage for breast reconstruction procedures. They might try to skirt the coverage requirement by technically complying and listing certain providers as reconstructive surgeons, when, in reality, those doctors perform little or no reconstruction at all. Even when a plan has an in-network doctor, payers often burden patients and physicians with excessive prior authorization processes, post-payment reviews and denials after care has been delivered.
To counter this, ASPS is pursuing state policies that require health insurance companies to maintain in-network providers who actually perform the full range of reconstructive options on a regular basis. ASPS believes that only a meaningful requirement for adequate networks of reconstructive surgeons will incentivize payers to negotiate in good faith to reach agreements with plastic surgeons.
In April 2025, Arkansas Governor Sarah Huckabee Sanders signed landmark legislation drafted and led by ASPS that establishes a benchmark for states in need of expanded breast reconstruction coverage. The new law:
- Requires insurers to cover the full spectrum of breast reconstruction options
- Requires insurers without an in-network provider for a specific type or technique of breast reconstruction to approve a single-case agreement with an out-of-network surgeon
- Requires payers without an in-network provider to reimburse an out-of-network surgeon at the lesser of the surgeon's charge or the 80th percentile of all charges in an appropriate FairHealth dataset
- Imposes treble damages for non-payment, payment denial, or underpayment of breast reconstruction services to out-of-network providers, payable by the insurer to the physician
To enact this bill, ASPS worked local ASPS members and Arkansas State Senator Joshua Bryant for more than a year while also assembling support from the Southeastern Society of Plastic and Reconstructive Surgeons, initiating a grassroots alert and gathering HIPAA-compliant examples of denied coverage for breast reconstruction surgery, breast cancer detection or breast cancer prophylaxis from across the nation.
Additional efforts are underway across the nation. ASPS continues to work alongside the local, state and regional plastic surgery societies, state medical associations, industry partners and patient-advocates to expand access to breast reconstruction and ensure fair reimbursements for the providers performing these procedures.
When state legislation is introduced, ASPS mobilizes its members to share patient stories, contact legislators and partner with state and regional plastic surgery societies and patient groups to demonstrate broad support for modernization.