DIEP Flap Breast Reconstructive Surgery: An Emerging Public Health Issue
- Alissar Dalloul
- Feb 24, 2023
- 2 min read
Insurance companies are using a loophole to avoid paying for a particular kind of breast reconstruction surgery for cancer survivors.
THE ISSUE
Insurance companies are using a loophole to avoid paying for a particular kind of breast reconstruction surgery for cancer survivors. Namely, the DIEP Flap Breast Reconstruction Surgery —a more viable reconstructive surgery for many breast cancer survivors who have had radiation and yet are not candidates for implants —may no longer be covered by insurance. This would leave breast cancer survivors with no viable reconstruction options — further damaging their emotional health and therefore physical health.
WHY? WHAT HAPPENED?
The Centers for Medicare & Medicaid Services (CMS) is in charge of managing the codes used to bill for medical procedures. By December 31, 2024, a bill from 2019 will go into effect where The DIEP Flap surgery and other reconstructive surgeries have the same code.
This poses an issue to breast cancer survivors, as surgeons performing DIEP flap surgery are only going to be able to bill insurance for a TRAM flap surgery — an older, less advanced, and frankly cheaper procedure that has been positively associated with long-term complications.
... If the CMS's determination and impending policy is not overturned quickly, all commercial health insurers might cease covering DIEP flap surgery by the end of the current year.
WHY IS THIS AN ISSUE?
According to the ASPS (American society of plastic surgeons), "more than 137,000 women who have been diagnosed with breast cancer undergo breast reconstruction surgery each year" (Breastcancer.org). Moreover, DIEP Flap surgery, a more preferred reconstructive mechanism, allows patients to use their own transplanted tissue —unlike an implant which involves moving/cutting muscle. This, therefore, results in a lower recovery time and a lower risk of complications than other reconstructive surgeries like the TRAM Flap surgery or implantation.
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