Impact of Health Insurance Contract Timing on Breast Reconstruction Completion

Cost of breast reconstruction can create a substantial burden for patients. As patients hope to maximize insurance plan benefits, it is crucial to receive efficient, cost-reducing care. This study analyzes the impact of insurance cycle [calendar-based insurance (CBI) versus non-calendar-based insurance (NCBI)] on breast reconstruction.

Between January of 2014 and 2018, patients undergoing postmastectomy breast reconstruction performed by two senior surgeons (N.T.H. and S.S.T.) at a single academic institution were retrospectively evaluated. Data were collected on insurance contract timing (CBI versus NCBI) and insurance payor.

A total of 514 patients were included: 136 patients on NCBI and 378 patients on CBI. Individuals enrolled in CBI were more likely than NCBI patients to have their last operation toward the end of the calendar year ( P < 0.0005). In addition, individuals on private CBIs are more likely to have their last operation closer to the end of the year than those on public CBIs ( P < 0.0001). Individuals enrolled in CBI were less likely to receive autologous reconstruction than individuals on NCBI ( P = 0.011). Among patients on private CBIs, patients with all major revisions were more likely to start their reconstructive journey earlier in the year than patients who did not finish major revisions ( P = 0.011). Lastly, individuals on private insurance also undergo more revision procedures than those on public insurance ( P < 0.0001).

Insurance contract cycle and payor impact the timing of breast reconstruction. This study emphasizes the importance of both patient and provider working toward maximizing health insurance plan benefits.