Insurance & Reimbursement
Did you know? Many breast care products are reimbursable
Adapted from Breast Cancer Wellness magazine, Winter 2008; last reviewed May 2012
Many women who have had breast surgery are not aware that their insurance may cover the purchase of post-operative garments, pocketed bras and breast prostheses, also known as breast forms. Most medical insurance policies base their coverage on Medicare standards which usually cover these products for post-operative breast care patients. However, the product coverage and allowed amount is dependent on the region as defined by Medicare.
If you are thinking “I don’t want a medical looking bra,” or I don’t want a hot and sticky breast form,” there’s no need to worry. You can find many of your favorite bra styles, including lacy, feminine, everyday, comfortable and active sports bras, as well as the latest breast forms such as Energy breast forms by Amoena. The Energy breast forms equalize temperature with innovative Comfort+, storing excess heat from the chest wall. The Energy forms also feature air flow pearls that create channels for optimum air circulation, making the skin feel pleasantly dry all day, every day.
Medicare guidelines deem the useful lifetime expectancy of a silicone breast form is two (2) years, and a non-silicone form has an expected lifetime of six (6) months. However, a breast form can be replaced at any time if it is lost, irreparably damaged (this does not include ordinary wear and tear), or if there is a change in the patient’s medical condition necessitating a different type of item. If the patient’s medical condition changes, it must be documented by the patient’s physician submitting a new prescription which explains the need for a different type of breast form.
The first step in exploring the new and stylish breast care products available today is to visit the Products > Breast Forms area of the Amoena website. Then, locate an Amoena retailer close to you using our Store Locator. Call the retailer of your choice and determine if she is knowledgeable about your insurance. If you are covered by Medicare, be sure the retailer has a Medicare Supplier Number. The retailer may choose to handle your purchase in one of two ways. It is important to ask if the retailer accepts Medicare assignment or does not accept Medicare assignment. Below, is a description between the two Medicare statuses.
- They may not take assignment and request payment from you in full, and then bill your insurance or Medicare on your behalf so that the reimbursement check comes to you.
- Or they may accept assignment. This will allow you to take the form without full payment, while the store files for direct reimbursement. In most cases, you will be expected to pay your insurance deductible/coinsurance responsibility.
Amoena retailers are there to help you determine what’s covered by your health insurance and what’s not. Their desire is to help you find the right products for you.
Help for those in need
Many foundations offer financial assistance for the uninsured or underserved. Note that each organization requires an application, and all grants are subject to eligibility verification.
- American Cancer Society / 800-ACS-2345 / http://www.cancer.org/ -- Referrals for financial assistance; some local offices provide transportation assistance, temporary housing, wig, prostheses, bras, or prescription assistance.
- CancerCare / 800-813-HOPE / http://www.cancercare.org/ -- Financial grants available for transportation, homecare, childcare and pain medications. Linking Arms Program can provide grants for breast cancer patients to help with selected supply costs.
- Patient Advocate Foundation / 866-512-3861 toll-free / http://www.copays.org/ -- Provides direct co-pay assistance for pharmaceutical products to insured breast cancer patients (including Medicare Part D beneficiaries) who financially and medically qualify.
Search locally and within your state to find other assistance organizations, if you are in financial distress about your medical expenses.