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Breast cancer care bill filed in Montgomery
- Scott Johnson
- Feb 12
- 5 min read
Health insurance plans are functionally limiting which breast cancer procedures are available in Alabama, according to advocates backing new legislation filed Thursday.
A bill sponsored by Rep. Jennifer Fidler, R-Silverhill, titled "The Breast Reconstruction Coverage and Patient Choice Act" seeks to change that landscape.
The proposal, filed as House Bill 435, would explicitly mandate all public and private healthcare plans to cover all stages of reconstruction following a mastectomy, lumpectomy, trauma, disease or prophylactic surgery, including revisions, symmetry procedures and treatment of complications.
Federal law currently requires reconstruction to be covered by health insurance; however, a summary of Fidler’s legislation explains that, in practice, the lack of a state-level requirement has bogged down reimbursements as carries have layered in their own interpretations.
The bill also defines breast reconstruction as medically necessary care rather than cosmetic surgery, limits patient cost-sharing to a carrier's innetwork rate, and authorizes patients to choose qualified surgeons and facilities regardless of network status.
“No woman residing in the state of Alabama should be denied access to appropriate breast reconstruction surgery due to network limitations or excessive administrative requirements,” the bill states.
Other provisions prohibit loss of other health benefits due to reconstructive surgery.
In an interview with Lagniappe, Fidler framed the bill around patient choice and reliable health care.
“I'm thrilled to support legislation that will help so many ladies get through one of the worst times of their lives,” she said. “One in eight women is going to be diagnosed with breast cancer. We don't realize how many women are affected — even those who you may be close to.”
Filder explained that this health battle doesn’t just end after a mastectomy. Different reconstruction methods — implants or tissue — carry different long-term consequences, she said.
In some circumstances, breast implants can create complications when the patient has been going through radiation, Filder said, also noting that implants can also increase necessary maintenance and increase risk exposure. There are various muscle and livetissue alternatives, some of which Fidler says should be readily available in Alabama but are not under the current environment, specifically autologous reconstruction, or DEIP.
Fidler’s bill follows Lagniappe’s reporting on Dr. Mark and Morgan Stalder’s battle with Blue Cross Blue Shield of Alabama while attempting to make the DEIP surgery available on the Alabama Gulf Coast.
The highly specialized procedure uses live fat tissue and vessels to form a new breast. While largely considered a more reliable, long-term option, the only provider offering it is in Birmingham. Those seeking the procedure in Mobile have had to travel to New Orleans to receive it.
Stalder began offering the surgery in 2024 at USA Health Providence Hospital. While he attempted to get in-network with BCBSAL, he claims the rates for the surgery were so low that it would have been financially impossible to practice. He alleges the saga put BCBSAL at odds with federal regulations, which Stalder explains allowed him to bill for the surgeries through arbitration despite being out-of-network. He claims the issue devolved into the carrier threatening Providence’s hospital contract unless it stopped allowing him to operate in the facility.
“Patients who wanted this surgery had to leave Alabama,” Stalder said in the earlier reporting. “A lot of them simply couldn’t do that. By the time you factor in time off work, childcare, travel, and recovery, it becomes unrealistic. For many patients, the option effectively doesn’t exist.”
The Stalders have worked together with Fidler in preparing the new legislation.
BCBSAL provided the following statement: "Effective Oct. 1, 2025, Blue Cross and Blue Shield of Alabama substantially increased the reimbursement rate for DIEP. On September 15, 2025, Dr. Stalder was formally notified of this increase and he confirmed receipt the following day, September 16, 2025. Despite this change, Dr. Stalder has elected to still remain outside of our network."
Speaking to Lagniappe, Fidler explained breast cancer patients in Alabama interested in alternatives are often left under-informed about what options there are with tissue reconstruction, the procedure they’re interested in is not available locally, or the doctor they want is out-of-network. She said this has left breast cancer patients functionally without choices.
“With implants, you often have tissue expanders, and that can mean two or three operations. And every time you go back in and reopen the area, you’re susceptible to infection,” she said. “I know someone personally who went in for her second expander procedure about a year ago and it got infected and she started to get sepsis. She still hasn’t gone back to finish the procedure.”
“We have so many new things that are happening with breast reconstruction, with breast cancer research. There's a need for women to be given options and make sure they understand what their options are. Making these women whole, and as whole as they can be is very important — emotionally, physically.”
Dr. Linsdey Beakley, a breast surgical oncologist at Southern Cancer Center in Mobile, is supporting the legislation. She said she continually finds patients are largely unaware of their treatment options after a mastectomy — an information void which is being taken advantage of.
“Some plastic surgeons are not supportive of women having another option — an option besides what they can provide,” Beakley told Lagniappe. “These are people I work with frequently and are colleagues and friends, but we definitely have different viewpoints on this. And from time to time, it has reared its ugly head.”
In a handful of cases, Beakley said patients have been interested in autologous reconstruction. However, when they consulted with their plastic surgeon, they were told they were not candidates. She said that the advice was coming from doctors unqualified to even perform the surgery in question.
“At the end of the day, when we decided to become physicians, it was to ‘do no harm.’ It might not be amputating the wrong leg, but personally, I think it’s harmful not to support options for women,” she said.
Fidler’s bill includes enforcement provisions authorizing civil actions by enrollees and health care professionals, including the potential for “treble damages” and attorney fees for knowing or reckless violations, as well as enforcement authority for the Attorney General and the Alabama Department of Insurance, the summary states.
The Stalders have been organizing events with lawmakers and stakeholders across the state over the last several months, under the name “Access4Alabama,” including a Jan. 10 luncheon event in Mobile with local stakeholders and lawmakers.
“Through our experience over the last two years, while providing these services to the women of Mobile, it became very apparent to us why nobody else was offering these specialized techniques,” the Stalders said in the release following the luncheon. “Insurance companies have created an environment of total control over network physician referrals, along with artificially low reimbursement for certain procedures to both the facility and the physician…where if a patient did not have the resources to seek these specialized services out of state, most simply did not receive the care.”
Fidler’s bill states it would take effect Oct. 1, 2026, with coverage requirements beginning Jan. 1, 2027.
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