New Alabama Bill Would Expand Breast Reconstruction Coverage

A new bill filed in the Alabama Legislature would overhaul the way health insurance covers breast reconstruction after mastectomy. House Bill 453 (HB453), sponsored by Representative Jennifer Fidler (R-Silverhill), seeks to make coverage more comprehensive and patient-centered across the State’s health plans.

Supporters of the legislation held a forum in Mobile in early February to highlight gaps in access that persist despite current legal mandates. Surgeons, survivors and lawmakers described situations where coverage “on paper” did not always translate to timely care or real choice for patients who have undergone mastectomy.

HB 453 requires all health insurance benefit plans issued in Alabama — private and public — to cover breast reconstruction surgery following mastectomy. The bill’s title and official summaries identify its focus on ensuring that insurers provide coverage for reconstruction procedures and protect patient choice in the method of reconstruction and their surgeon.

HB 453 would:

• Require all health insurance plans in Alabama — including private plans, those covering public employees, and the Medicaid program — to cover breast reconstruction surgery. 
• Allow individuals the choice of reconstruction type and surgeon, even if the surgeon is outside the insurer’s network. 
• Establish coverage rules for cost-sharing (such as deductibles and co-pays) and how insurers must pay out-of-network providers. 
• Provide legal remedies if an insurer fails to comply, including enforcement by the Attorney General and the State Insurance Commissioner, and allowing individuals or doctors to bring civil actions. 
• Apply these coverage requirements beginning January 1, 2027.

On Monday, Rep. Fidler took to Facebook to say this about HB453:

“This session, I am sponsoring the Comprehensive Breast Reconstruction Coverage Act (HB453) — legislation ensuring breast reconstruction after cancer is treated as medically necessary care, not cosmetic care. The bill protects survivors from insurance delays, guarantees coverage across all health plans in Alabama, and preserves a patient’s right to choose her qualified surgeon when specialists are limited.

“At its heart, this legislation removes barriers during one of the most vulnerable seasons of a woman’s life.”

At the federal level, the Women’s Health and Cancer Rights Act of 1998 already requires group health plans that cover mastectomies to also cover related reconstructive surgery, symmetry procedures, prostheses and treatment of complications. However, advocates say that this federal law doesn’t always guarantee timely or full access in practice, especially when insurers interpret contracts narrowly or impose restrictive network and authorization rules.

Under current Alabama law, coverage mandates for breast reconstruction from State programs are limited. For example, Medicaid reimburses breast reconstruction following a medically necessary mastectomy under specific conditions, such as requiring prior authorization and treatment within two years of surgery, and does not always cover procedures after non-cancer mastectomies.

HB 453 would extend a more uniform standard to all health benefit plans in the State — sitting alongside federal law but tightening the rules and enforcement mechanisms at the state level. In doing so, it aims to close the “coverage vs. access” gap highlighted by patients and surgeons alike.

Reporting from Lagniappe Mobile documented instances where breast cancer patients were handed consent forms stating that “services … necessary for the treatment of your condition … are not covered by your … health benefits contract,” leaving patients to shoulder the cost or travel long distances. That kind of experience underlines why lawmakers and survivors are pressing for more clearly defined rights and standards.

Backers of the bill argue that clearer Statewide coverage requirements coupled with stronger mechanisms for patient choice and insurer accountability could reduce administrative delays, cut down on out-of-pocket costs, and make advanced reconstructive procedures more accessible for patients recovering from breast cancer surgeries.

HB453 was introduced in the House and has been referred to the House Insurance Committee.

The full text of HB453 as originally filed may be read at THIS LINK.