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Lawmakers push to have DIEP flap surgery covered by insurance in Arkansas

A patient talks about her experience with the reconstruction surgery, as a state lawmaker prepares to push a bill that would make insurance companies cover it.

ROGERS, Ark. — While implants are an option after a mastectomy, there's also an option for breast cancer survivors that uses their own tissue from their abdomen area, but convincing insurance to cover it can be a major challenge. 

That's why finding a surgeon who can perform it is another hurdle.

Mercy Hospital Northwest Arkansas is the only hospital in the state offering this type of procedure, called DIEP flap surgery. 

Shannon Ellis survived breast cancer, but she says the mastectomy changed her body and she didn't fully feel like herself afterward. 

"I had made it through cancer and I was so grateful, but I was shocked every morning, every morning by my appearance," Ellis recalled. "It has really meant everything to be restored."

Shannon, who is from Arkansas, had the DIEP flap surgery performed at Mercy in Rogers a little more than a year ago. 

After spending five years facing insurance denials and looking all over the country for a doctor who could do the surgery, Shannon said it all came together for her at Mercy NWA after a surgeon who could do it took a job there. 

"Being able to do it here really meant everything — the difference between having it or not."

Dr. Kasia Kania from Taylor Plastic Surgery, a clinic that partners with Mercy to offer this surgery, said the DIEP flap procedure has been around since the 1980s. 

"What I'm really excited about, we're able to offer this surgery now locally when before patients had to travel," Dr. Kania emphasized. 

However, she pointed out that health insurance companies typically offer poor reimbursement rates that don't come close to what the surgery, which can take up to twelve hours to perform, costs. 

"The reimbursment rate is so low, it's well below the market rate nationally," Dr. Kania said. 

Arkansas State Senator Joshua Bryant, a Republican from the 32nd district, said he's working to fix that.

He plans to sponsor a bill in the 2025 legislative session that would require insurance companies to cover what's been called the "gold standard" procedure for breast reconstruction. 

"In Arkansas, we always talk about access to care, getting the appropriate surgeons here and getting medical necessities here in our state, in our region, and then to say we're just not going to provide that level of care, I think legislation is needed," Bryant said. 

Shannon said not every woman wants or can even be a candidate for implants, which can rupture, need to be replaced every decade or so, and in some cases even make the patient ill. 

"I just want it to be a choice for every woman on the table, and paid for, should she choose to have it," Shannon said. 

Shannon said her recovery from DIEP flap surgery has been great, and if she hadn't done it in Arkansas, she would have had to travel to New Orleans and pay out of pocket for the procedure.

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