MMC Benefits Handbook
Mastectomy – Reconstructive Surgery
Does the Plan cover mastectomy-related services?
NOTE: Out-of-network services are not covered under the Anthem BCBS Narrow Network (National Blue High Performance Network (Blue HPN)) except for urgent and emergency care. There are some providers in New Jersey and Philadelphia that are listed as Tier 2 on Anthem BCBS's provider search (National Blue High Performance Network (Blue HPN)) that can be used and are covered at the out-of-network benefit level. Providers not labeled as Tier 2 cannot be used for out of network coverage.
Yes, the Plan covers mastectomy-related services. Coverage will be provided in a manner determined by the attending physician and the patient. The covered services include:
  • All stages of reconstruction of the breast on which the mastectomy was performed,
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance,
  • Prostheses, and
  • Treatment of physical complications of the mastectomy, including lymphedema.
What are the applicable deductibles and coinsurance for mastectomy-related benefits under the Plan?
The mastectomy-related benefits are subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this Plan. See the "Detailed List of Covered Services" for the applicable mastectomy – reconstructive surgery coverage.