MOBILE, Ala. — As Breast Cancer Awareness Month begins, a Baldwin County lawmaker says she will try again next year to pass breast reconstruction coverage legislation that would let Alabama women who have survived cancer choose the reconstruction method they and their surgeon decide is best, without being steered to a cheaper option by their insurer.
State Rep. Jennifer Fidler, R-Silverhill, said she plans to reintroduce the bill in the Legislature’s next session after it stalled this year. Doctors and advocates backing the effort say some Alabama patients are traveling out of state and paying tens of thousands of dollars out of pocket to get the procedure they need.
‘A Second Mortgage’ to Pay for Care
Dr. Lindsey Beakley, a breast surgical oncologist, said two of her own patients are in exactly that position.
“No woman faced with a breast cancer diagnosis should have to take a second mortgage out on their family’s home to get appropriate treatment,” Beakley said.
Beakley said insurance reimbursement limits the reconstruction options available to women in Alabama, and that coverage now shapes the conversation in her exam room.
“When I am in clinic and talking to patients about their reconstruction options, I unfortunately have to ask them who their insurance provider is. It’s the elephant in the room,” she said.
Covered on Paper, Out of Reach in Practice
Federal law already requires reconstruction coverage in many cases. The Women’s Health and Cancer Rights Act of 1998 requires group health plans and insurers that cover mastectomies to also cover breast reconstruction, including surgery on the other breast to produce a symmetrical appearance, prostheses, and treatment of physical complications.
But advocates say that guarantee does not always translate into access. Morgan Stalder, whose husband is a breast reconstruction surgeon, founded Access4Alabama, an advocacy group for breast cancer patients. She said coverage on paper does not mean a patient can actually get the procedure or the surgeon she needs.
Stalder stressed that reconstruction after cancer is neither a luxury nor a cosmetic procedure.
“Oftentimes, women are left in a position where they are going to have an inferior operation for them, or they are left senselessly deformed and go without this medically necessary reconstruction,” Stalder said.
What Fidler’s Bill Would Do
Fidler introduced the measure during the 2026 regular session as House Bill 453. It drew 51 co-sponsors from both parties but did not advance out of the House Insurance Committee before the session ended.
As described by Fidler and supporters, the proposal would:
- Require health plans, including Medicaid and public employee plans, to cover the reconstruction method the patient and her doctor choose.
- Bar insurers from denying a reconstruction method simply because another option costs less.
- Allow patients to use an out-of-network surgeon while paying in-network cost-sharing rates.
The 2026 version also called for insurers to respond to prior authorization requests within three business days and to deny procedures only when they lack medical necessity, according to the bill’s legislative summary.
“Women deserve to have the reconstruction that they see is best for their body,” Fidler said.
Fidler said the issue reaches beyond the patients themselves.
“I hope Alabama can stand up for the ladies of our state and the families, because it’s not just the ladies, you know, those patients, it’s the families that love them, the men who love them, and want to make sure that they feel as whole as they possibly can, and this is what this bill does,” she said.
The Legislature’s next regular session is scheduled for 2027. A bill reintroduced then would again need committee approval in the House before it could reach the floor.
Why Reconstruction Methods Matter
Breast reconstruction can be performed with implants or with a patient’s own tissue, often taken from the abdomen, back or thighs. Tissue-based procedures, particularly microsurgical techniques, can require specially trained surgeons and longer operating times, and they are typically reimbursed differently than implant-based reconstruction. The right choice depends on a patient’s body, cancer treatment, radiation history and personal preferences — which is why physicians and advocates argue the decision should rest with the patient and her surgeon.
When few in-network surgeons in a state perform a given technique, patients who want it may have to travel or pay out-of-network rates, which is the situation supporters of Fidler’s bill describe.
A New Tool for Assessing Risk
Breast Cancer Awareness Month also brought a new option for women who want to better understand their own risk. Clairity Breast, the first artificial intelligence platform authorized by the U.S. Food and Drug Administration to predict a woman’s five-year risk of developing breast cancer from her existing mammogram, became available to consumers nationwide on Oct. 1.
The software received FDA De Novo authorization in 2025. It analyzes a routine screening mammogram for patterns that are not visible to the human eye. Through the new consumer offering, women 35 and older with a qualifying mammogram from the past 12 months can request the assessment, which is reviewed and ordered by a licensed clinician. The test costs $250 and is eligible for payment with flexible spending and health savings accounts.
Developers note that most breast cancers occur in women with no family history of the disease, and the tool is meant to help identify women at elevated risk who might benefit from more personalized screening.
Screening and Support Close to Home
Women in southwest Alabama are encouraged to talk with their doctors about when to begin screening mammograms and how often to have them. New state-administered rural health grants announced this week will also fund a Southwest Alabama Breast Cancer Detection Network through Infirmary Health, expanding screening, diagnostic follow-up and specialty care in Baldwin, Choctaw, Clarke, Conecuh, Escambia, Monroe and Washington counties.
Women with questions about reconstruction coverage under their own plans can ask their insurer for the plan’s written policy on post-mastectomy reconstruction and request an explanation in writing if a specific procedure or surgeon is denied.