Is Areola Tattoo Covered by Insurance? A Complete Guide to the Women's Health and Cancer Rights Acting Florida

If you're a breast cancer survivor who has undergone a mastectomy or breast reconstruction, you may

be wondering: "Is areola tattoo covered by insurance?"

The answer is often YES—but many women don't know about their legal rights.

Under the Women's Health and Cancer Rights Act of 1998 (WHCRA), also known as Janet's Law,

health insurance plans that cover mastectomy are required by federal law to also cover all stages of

breast reconstruction—including 3D areola and nipple tattooing.

At Imagine You New in St. Petersburg, Florida, we help breast cancer survivors navigate insurance

coverage for areola restoration. We also train medical professionals at the International Institute of

Medical Tattoo Science and Artistry (www.medtattooeducation.com) to provide this life-changing

service.

This guide will walk you through everything you need to know about insurance coverage for areola

tattoos, including how to get reimbursed, what to expect with deductibles, and how to work with your

plastic surgeon.

Table of Contents

1. What is the Women's Health and Cancer Rights Act (WHCRA)?

2. Does WHCRA Cover Areola Tattoos?

3. Who is Eligible for Insurance Coverage?

4. What Insurance Plans Are Required to Cover Areola Tattoos?

5. What is Covered Under WHCRA?

6. What is NOT Covered Under WHCRA?

7. How Does Insurance Reimbursement Work for Areola Tattoos?

8. Understanding Deductibles, Co-Pays, and Out-of-Pocket Costs

9. How to Work with Your Plastic Surgeon for Insurance Approval

10. CPT Codes and Documentation Needed for Insurance Claims

11. What to Do If Your Insurance Denies Coverage

12. Imagine You New: How We Help with Insurance

13. Frequently Asked Questions

1. What is the Women's Health and Cancer Rights Act (WHCRA)?

The Women's Health and Cancer Rights Act (WHCRA) is a federal law passed in 1998 that

protects the rights of breast cancer patients who choose to have breast reconstruction after a

mastectomy.

The Story Behind the Law: Janet's Law

The law is also known as "Janet's Law" after Janet Franquet, a young woman from Long Island who

was diagnosed with aggressive breast cancer in 1997.

After her mastectomy, Janet's insurance company refused to cover breast reconstruction, calling it

"cosmetic." They instead offered a cheaper skin graft. Her surgeon, Dr. Todd Wider, performed the

reconstruction for free—but he didn't stop there.

Dr. Wider reached out to Senator Alphonse D'Amato, who championed legislation to ensure no other

woman would face the same financial barrier. Thanks to their advocacy, WHCRA was passed with

overwhelming bipartisan support and became federal law on October 21, 1998.

Why This Law Matters

Before WHCRA, only a few states required insurance companies to cover breast reconstruction. Many

breast cancer survivors were left without coverage, creating financial strain and limiting access to

restorative procedures—including areola tattooing.

WHCRA changed that forever.

2. Does WHCRA Cover Areola Tattoos?

YES. Areola and nipple tattooing is considered part of breast reconstruction under WHCRA.

The law states that insurance plans must cover:

• 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 (breast forms) and treatment of physical complications

3D areola tattooing falls under "all stages of reconstruction."

While the law doesn't explicitly list "tattooing" by name, it has been widely interpreted to include areola

restoration as the final stage of breast reconstruction.

3. Who is Eligible for Insurance Coverage?

You may be eligible for insurance coverage if:

■ You had a mastectomy (full or partial breast removal)

■ You are receiving benefits in connection with a mastectomy

■ You elect to have breast reconstruction

■ Your health plan covers mastectomies

WHCRA applies to:

• Breast cancer survivors

• Women who had preventive mastectomies (BRCA gene carriers)

• Women who had mastectomies due to other medical reasons

Important: There is no time limit under WHCRA. You can have areola tattooing done immediately

after reconstruction or years later—the law still applies.

4. What Insurance Plans Are Required to Cover Areola Tattoos?

WHCRA applies to two types of coverage:

1. Group Health Plans (Employer-Sponsored Insurance)

• Provided by your employer or union

• Covers employees and their dependents

2. Individual Health Insurance Policies

• Purchased directly (not through an employer)

• Subject to the same WHCRA requirements

Note: If you have individual coverage, you have the same rights and protections as those with

employer-based plans.

5. What is Covered Under WHCRA?

Insurance plans that cover mastectomy must cover:

Breast Reconstruction Services:

• Breast reconstruction surgery (all stages)

• Areola and nipple tattooing (3D areola restoration)

• Surgery on the opposite breast to achieve symmetry

• Breast implants or tissue flap reconstruction

Related Medical Needs:

• Breast prostheses (breast forms)

• Post-mastectomy bras

• Treatment of complications (e.g., lymphedema, infections)

6. What is NOT Covered Under WHCRA?

While WHCRA provides broad protections, there are some limitations:

■ Procedures unrelated to breast cancer (e.g., elective breast augmentation)

■ Deductibles, co-insurance, or co-pays (you may still owe these)

■ Out-of-network providers (may not be fully covered)

■ Preventive mastectomy without cancer diagnosis (coverage varies by plan)

■ Travel, lodging, or personal expenses

■ Cosmetic procedures not related to reconstruction

Important: Some insurance plans do NOT cover areola tattooing performed by a non-medical tattoo

artist or in a non-medical setting. This is why working with a licensed paramedical tattoo artist like

those at Imagine You New is critical.

7. How Does Insurance Reimbursement Work for Areola Tattoos?

Most areola tattoo providers (including Imagine You New) operate on an out-of-pocket,

reimbursement basis. Here's how it works:

Step 1: Pay Upfront

You pay for the procedure at the time of service using cash, credit card, or financing (we offer flexible

payment plans).

Step 2: Receive Documentation

We provide you with:

• Letter of Medical Necessity (explains why the procedure is medically necessary)

• Itemized Receipt with:

- Provider NPI number

- CPT codes (procedure codes)

- Date of procedure

- Location where performed

Step 3: Submit to Insurance

You submit the documentation to your insurance company for reimbursement.

Step 4: Get Reimbursed

Most insurance companies reimburse patients within 4-8 weeks. Some may give pushback—if this

happens, we'll help you appeal.

8. Understanding Deductibles, Co-Pays, and Out-of-Pocket Costs

Even if insurance covers areola tattooing, you may still owe out-of-pocket costs depending on your

plan:

Deductible

The amount you must pay before insurance starts covering costs.

• Example: If your deductible is $2,000 and you haven't met it yet, you'll pay the full cost of areola

tattooing out-of-pocket. Once you meet your deductible, insurance will cover future procedures.

Co-Insurance

The percentage you pay after meeting your deductible.

• Example: If your plan has 20% co-insurance, you'll pay 20% of the procedure cost and insurance

pays 80%.

Co-Pay

A fixed amount you pay per visit.

• Example: $50 co-pay per session.

Out-of-Pocket Maximum

The maximum you'll pay in a year. After you reach this, insurance covers 100%.

Pro Tip: If you're having areola tattooing done in the same year as your mastectomy or reconstruction,

you may have already met your deductible/out-of-pocket max—meaning insurance could cover most

or all of the cost.

9. How to Work with Your Plastic Surgeon for Insurance Approval

Getting a referral or letter of support from your plastic surgeon can strengthen your insurance

claim.

What to Ask Your Plastic Surgeon:

• "Can you provide a letter stating that areola tattooing is part of my breast reconstruction?"

• "Can you include the procedure in my reconstruction treatment plan?"

• "Do you have a preferred areola tattoo artist you refer patients to?"

Many plastic surgeons are familiar with WHCRA and will gladly write a letter supporting your claim.

10. CPT Codes and Documentation Needed for Insurance Claims

Insurance companies require specific codes to process claims. Here are the codes we use:

Procedure Code (CPT Code):

CPT 11921 – Tattooing and intradermal introduction of insoluble opaque pigments to correct color

defects, including micropigmentation (6.1 to 20.1 sq cm)

Diagnosis Codes (ICD-10):

• Z42.1 – Encounter for breast reconstruction following mastectomy

• V45.71 – Acquired absence of breast secondary to mastectomy for breast cancer

• Z90.1 – Acquired absence of breast and nipple

Your insurance company may also request:

• Date of mastectomy

• Date of reconstruction surgery

• Provider NPI number

We provide all of this documentation for you.

11. What to Do If Your Insurance Denies Coverage

If your insurance denies your claim, don't give up. Here's what to do:

Step 1: Request a Written Explanation

Ask your insurance company for a written denial letter explaining why they denied coverage.

Step 2: File an Appeal

Most insurance companies allow you to appeal a denial. Include:

• Letter from your plastic surgeon

• Copy of WHCRA law

• Documentation showing areola tattooing is part of reconstruction

Step 3: Contact the Department of Labor

If your appeal is denied, you can file a complaint with the U.S. Department of Labor's Employee

Benefits Security Administration (EBSA) at 1-866-444-3272.

Step 4: Seek Legal Assistance

If your rights under WHCRA are being violated, you may want to consult with a healthcare attorney.

We've helped countless clients successfully appeal denials. We're here to support you.

12. Imagine You New: How We Help with Insurance

At Imagine You New, we make the insurance process as easy as possible:

■ We provide all documentation (Letter of Medical Necessity, itemized receipts, CPT codes)

■ We work with your plastic surgeon to coordinate care

■ We offer flexible financing if you need to pay upfront

■ We help you appeal denials if insurance pushes back

Our goal: Make sure you get the restoration you deserve without financial stress.

13. Frequently Asked Questions

Q: Do I have to use a specific tattoo artist for insurance to cover it?

A: No, but using a licensed paramedical tattoo artist in a medical setting increases your chances of

approval.

Q: Will insurance cover touch-ups?

A: Maybe. Some plans cover one initial session only; others cover touch-ups. Check with your plan.

Q: Can I get areola tattooing if I had a lumpectomy (not a full mastectomy)?

A: WHCRA applies to mastectomy patients. If you had a lumpectomy, coverage may vary.

Q: What if I had my mastectomy 10 years ago?

A: No problem! There's no time limit under WHCRA.

Q: Will Medicare or Medicaid cover areola tattoos?

A: Medicare and Medicaid coverage varies by state. Contact your plan for details.

Conclusion: You Have Rights—Use Them

If you're a breast cancer survivor, you have the legal right to insurance coverage for areola tattooing

under the Women's Health and Cancer Rights Act.

Don't let cost be a barrier to completing your breast reconstruction journey.

Ready to get started?

■ Imagine You New

St. Petersburg, FL | Serving Tampa, Clearwater, Sarasota & Orlando

■ (727) 729-9069

■ www.imagineyounew.com

Training for Professionals:

www.medtattooeducation.com – International Institute of Medical Tattoo Science and Artistry