Mastectomy, Mammograms and the Fibrocystic Rule

Florida mandates post-mastectomy coverage for prosthetic devices and reconstructive surgery, including all surgeries to restore symmetry between the breasts; inpatient mastectomy stays can't be cut below what the physician (after consulting the patient) finds medically necessary; outpatient postsurgical care must be comparable to inpatient; a person breast-cancer free for two (2) years can't be denied or excluded from breast cancer coverage; follow-up care is NOT a preexisting-condition evaluation. Mammogram minimums: baseline at 35–39 · every 2 years at 40–49 (or more often per the physician) · every year at 50+ · one or more a year at any age with a personal/family history of breast cancer. Fibrocystic exclusion prohibited: no denial, nonrenewal, or benefit exclusion solely for a fibrocystic condition, non-malignant lesion, or family history — UNLESS a breast biopsy demonstrates an increased disposition to develop breast cancer.

Reconstruction, symmetry, and follow-up are covered; the mammogram calendar is 35-39 baseline, 40s every other year, 50+ yearly; and "lumpy but benign" is not a reason to deny anyone.