Introduction: Your Best Option Should Also Be Covered
Insurance should never stand between you and the best reconstruction for your body. Under federal protections and typical Connecticut insurance plans, DIEP flap breast reconstruction is covered — whether it’s done immediately at mastectomy or years later as a delayed procedure.
At Hartford Hospital and St. Francis Hospital & Medical Center, The DIEP Group manages preauthorizations, appeals, and insurance navigation for patients across Hartford, West Hartford, East Hartford, Manchester, New Britain, Bristol, Meriden, Middletown, Glastonbury, and Wethersfield.
Key point: You do not need implant problems for coverage. Elective implant-to-DIEP conversions are typically covered because DIEP is considered reconstructive, not cosmetic.
Visit our Before and After DIEP Flap Gallery
The Law That Protects You: WHCRA
The Women’s Health and Cancer Rights Act (WHCRA) requires most group health plans covering mastectomy to also cover:
- Breast reconstruction (including DIEP flap)
- Opposite-breast symmetry procedures
- Treatment of complications like capsular contracture
- Nipple reconstruction and 3D tattooing
This applies to immediate and delayed reconstruction.
When Insurance Typically Approves DIEP
- Immediate DIEP during mastectomy (one or both sides)
- Delayed DIEP months or years later
- Failed implant reconstructions or unsatisfactory cosmetic results
- Radiation-related implant problems (pain, tightness, deformity)
- Capsular contracture (hard, painful implants)
- Implant rupture/leakage
- Recalled textured silicone breast implants
- Elective implant-to-DIEP conversion to avoid future exchanges or leaks
Implants vs. DIEP: What Coverage Means in Real Life
| Consideration | Implants | DIEP Flap (Autologous) |
| Insurance after mastectomy | Covered | Covered (immediate & delayed) |
| Longevity | Exchanges ~10–15 yrs | Permanent |
| Radiation tolerance | High risk of problems | Better outcomes |
| Feel/temperature | May feel cool/firm | Warm, soft, natural |
| Leak/rupture risk | Yes | No device |
| Adapts with weight | No | Yes |
| Abdominal benefit | None | Yes, tummy-tuck–like |
Our Insurance Process for Hartford Patients
- Benefit check: Confirm coverage for DIEP under your plan.
- Documentation: Gather medical records, mastectomy notes, implant history, and photos (if required).
- Preauthorization: Submit detailed operative plan with correct CPT/ICD-10 codes.
- Appeal if needed: Provide surgeon letters, research evidence, and arrange peer-to-peer reviews.
- Cost transparency: Review deductibles, copays, and coinsurance before surgery.
What Costs Are Typically Covered
- Hospital stay (2 days) at Hartford or St. Francis
- Flap monitoring and ERAS pain control
- Revisions and opposite-breast procedures for symmetry
- Nipple reconstruction and tattooing
- Follow-up visits
You’re only responsible for plan-specific items like deductibles and copays.
The “Tummy Tuck” Question (and Insurance)
Patients often ask: “Is DIEP like a tummy tuck, and is that covered?”
Because the tissue comes from your lower abdomen, patients enjoy a flatter belly and smoother contour. While it’s not billed as a cosmetic tummy tuck, the benefit is included in your reconstructive coverage.
Implant-to-DIEP Conversions: Covered in Connecticut
Many Hartford patients switch to DIEP after:
- Capsular contracture
- Radiation-altered implants
- Rupture/leakage
- Recalled implants
- Elective choice to avoid ongoing exchanges
Coverage typically applies in all scenarios, even without active implant failure.
Patient Testimonial — Manchester, CT
“I had implants for years and was tired of the pain and the thought of replacing them again. The DIEP Group got my insurance approved at Hartford Hospital, and now I have natural, soft breasts and don’t have to worry about future exchanges. I even got a flatter stomach.”
— K.R., Manchester, CT
FAQs — Hartford Patients Ask
Is DIEP covered if my mastectomy was 10 years ago?
Yes. Delayed DIEP is typically approved.
Can I switch to DIEP if my implants are “fine”?
Yes. Insurance usually covers elective implant-to-DIEP conversions.
Does insurance cover recalled implant removal with DIEP?
Yes, often in the same operation.
How long is the hospital stay?
2 days at Hartford or St. Francis.
Is DIEP better after radiation?
Usually yes—autologous tissue is more reliable than implants in radiated fields.
Are revisions and tattooing covered?
Yes, when related to mastectomy reconstruction.
Service Areas
Hartford, West Hartford, East Hartford, Manchester, New Britain, Bristol, Meriden, Middletown, Wethersfield, Glastonbury, Newington and central Connecticut.
Internal Links (Hartford Series)
- DIEP Flap Breast Reconstruction in Hartford, CT — Complete Guide
- DIEP Flap Recovery in Hartford, CT — What to Expect at Hartford Hospital & St. Francis
- Insurance Coverage for DIEP Flap in Connecticut
Take the Next Step
If you’re planning mastectomy, struggling with implants, or ready for a natural, permanent reconstruction, we’ll help secure insurance coverage and perform your surgery at Hartford Hospital or St. Francis.
The DIEP Group
203-200-0828
thediepgroup.com
Hartford Hospital & St. Francis · Hartford, CT
