Your provider will give you all of the information you need regarding what your policy allows, how much it will pay, how many bras and breast forms you are eligible for each year, and if you require pre-authorization.
While there is some variance among insurance providers regarding coverage, most major medical insurance policies cover mastectomy products within specific guidelines. Many insurance plans will cover one breast prosthesis (breast form) per year per effected side. Most insurance companies will cover two to four mastectomy bras per year, provided that you submit a prescription from your physician. It is your responsibility to know what your plan will cover. Unfortunately, our fitting experts cannot know nor look up every individual plan and what it entails.
Medicare provides partial reimbursement for breast forms, mastectomy bras and post-surgical camisoles regardless of when you had surgery. Currently, the allowable is:
- One silicone breast form (two forms for bilateral surgeries) every two years or one non-silicone form (two forms for bilateral surgeries) every six months.
- As many bra as are medically needed which is indicated by your physician. Additional bras may be prescribed as a result of surgery and/or loss or gain of weight.
- As many post-surgical camisoles as are medically necessary.
Isabella Boutique Files Your Insurance Claims For You
Isabella Boutique will file your primary and crossover claims for you. Any remaining balance resulting from a deductible or co-pay will be billed to you after Insurance settles. If known, you maybe asked to pay a deductible or co-insurance/co-pay at time of service.
Out of Network insurance customers may be asked to pay the total amount upfront. In these cases we will bill as non-assigned, therefore your insurance company will send any reimbursement straight to you instead of the Boutique.
Simply bring in your Insurance card, driver’s license, and a prescription from your physician.
The Women’s Health and Cancer Act of 1998
Under the Women’s Health and Cancer Act of 1998, insurance carriers are required to provide benefits to post-breast surgery patients. Benefits are provided to women who have had a mastectomy, reconstruction, lumpectomy or surgery to achieve symmetry between the breasts. Benefits provided are subject to deductibles and co-insurance applicable to your policy.