The Cost of DIEP Flap Surgery: Understanding Insurance Coverage and Financing Options

Is the Cost of DIEP Flap Reconstruction Covered by Insurance?

Insurance coverage for DIEP Flap surgery varies significantly based on whether the procedure is classified as reconstructive or cosmetic. Under the Women's Health and Cancer Rights Act of 1998 (WHCRA), all group health plans and individual health insurance policies that cover mastectomies must also cover breast reconstruction procedures, including DIEP flap surgery. This federal law ensures any reconstruction after breast cancer, for example, is treated as a medically necessary procedure, not a cosmetic one, and insurance companies are required to cover both the initial reconstruction and any revision surgeries needed to achieve symmetry. 

DIEP Flap surgery performed for purely cosmetic reasons, however, such as for breast enhancement, is typically not covered by insurance and must be paid for by the patient out-of-pocket. 

How Much Does DIEP Flap Surgery Cost If It Isn’t Covered By Your Insurance?

Like many procedures, the cost of DIEP flap reconstruction surgery is influenced by several factors. The surgeon's fees typically make up a significant portion of the total cost, reflecting their specialized microsurgical expertise and the complex nature of the procedure. Hospital charges include the operating room time as well as the multi-day hospital stay required for recovery and monitoring. 

Given the lengthy duration of the surgery, anesthesia fees are another major component. Where you live or the location where the procedure is taking place also plays a notable role in pricing, with costs generally higher in major metropolitan areas and at prestigious medical centers. 

Finally, the complexity of your specific case can also impact the final DIEP flap surgery cost—factors like bilateral reconstruction, breast revisions, or the need for additional procedures can increase the overall expense. 

Financing Options for DIEP Flap Surgery

If you are unsure of the costs or coverage for your specific situation, it is helpful to know many surgeons and medical facilities offer financing options if the procedure is not covered by your insurance plan. CareCredit, a popular healthcare credit card, provides specific financing plans for medical procedures with promotional periods and deferred interest. Some hospitals and surgical centers also partner with third-party financing companies that offer medical loans with fixed interest rates and structured repayment plans. 

Additionally, patients might consider working with their bank or credit union to secure a personal loan or line of credit. Many surgical practices also offer in-house payment plans that allow patients to spread their costs over several months. 

Final Thoughts on Managing Costs and Coverage

Understanding the financial aspects of DIEP flap surgery is key for effective planning and a positive outcome. Before proceeding with surgery, patients should verify their insurance coverage, understand their out-of-pocket responsibilities, and discuss any concerns with their insurance provider. 

"Surgery is a significant event," stresses Dr. Minas Chrysopoulo. "As we always tell our patients, ensuring every detail is addressed beforehand can greatly ease the stress of healing and recovery process in general."

Your surgical team at The Breast Center of New Jersey can help navigate these financial considerations. If you are ready to explore your options for DIEP flap surgery, contact The Institute for Advanced Reconstruction for a consultation today.