A Fitting Experience Mastectomy Shoppe is a women-owned and operated company that caters to women after any type of breast surgery. Since 1997, we have proudly served the South Florida breast cancer survivor community and beyond. To assist cancer survivors across the country, we have expanded our insurance processing services to all 50 states. We offer virtual fittings for new and existing surgeries with our licensed, accredited fitters.
Does Insurance Cover All Mastectomy Products?
The Women’s Health and Cancer Rights Act of 1998 (WHCRA) helps protect mastectomy patients receiving any type of breast cancer surgery or reconstruction. It ensures that insurance companies cover the cost of a variety of necessary mastectomy products, including breast forms, mastectomy bras, and post-surgical compression bras.
Whether you have Medicare, Medicaid, or private health insurance, all have insurance plans designed to facilitate a fast and comfortable recovery. However, there may be limitations to what you can claim.
Most standard insurance covers four to six post-surgery bras each year, depending on your provider, level of coverage, and medical needs. The style of bra also impacts your eligibility for coverage. Most providers only allow claims on pocketed post-mastectomy bras.
Claims on a mastectomy bra are typically not processed until after your surgery. We suggest coming in for a professional bra and breast form-fitting at four to six weeks after your mastectomy to allow for post-surgical swelling to subside and the site to heal properly.
Many health insurance providers, excluding Medicare and Aetna, offer coverage for custom breast prostheses. You are eligible for a new custom breast prosthesis every two years. You can also get a new lightweight foam breast form every six months on most commercial insurance plans.
Suppose you require a new breast prosthesis or bra due to loss, damage, or weight fluctuations. In that case, you may be able to purchase and claim additional products if you obtain a prescription from your doctor, deeming them medically necessary.
Compression garments are often necessary after extensive breast surgery and lymph node removal to prevent lymphedema. Unfortunately, Medicare does not provide coverage for compression sleeves or tights. However, you may be eligible for a compression vest, bra, or chest belt under your current plan.
How Can I Make a Claim?
With the team at A Fitting Experience Mastectomy Shoppe, it’s easy to file a claim. Our office staff contacts the insurance company department responsible for reviewing insurance claims and policy processing clerks to verify your benefits.
Some health care providers require prior authorization of a product before we can make a claim on your behalf. To make a claim for you, the insurance company needs us to have copies of your medical records and a doctor’s prescription before obtaining permission from your insurance company. We can contact your doctor for a prescription or referral on your behalf.
Your privacy, security, and safety are important to us. You can use our online portal to fill out your claim forms or paperwork. We are HIPAA compliant, and to access the records, you must have a secure password.
What is the Difference Between Copay, Deductible, and an Out-of-Pocket Maximum?
Whether you have health insurance, life insurance, or any other type of private insurance coverage, the company often will not cover the total cost of your claim.
A deductible is an amount you need to pay before the company fulfills your claim. Co-pay is the cost of routine services that are not covered by your deductible. Out-of-pocket maximum refers to the maximum total amount you will need to pay every calendar year, including copays and deductibles.
This can impact how much you will need to pay for your mastectomy bra, breast prosthesis, and any other mastectomy products. Contact our experienced customer service staff for guidance on claiming on insurance applications to ensure that all questions about insurance and mastectomy bras are answered. Let us help you to feel confident that your purchase won’t put you under financial strain.
If, after reviewing insurance applications and benefits, it is found that you aren’t eligible for benefits covering the cost of the mastectomy products you need, talk to our friendly staff about affordable payment options.
Which Health Insurance Companies Do We Work With?
We are proud to work with a vast network of popular health insurance providers to ensure that you can get the mastectomy products you need at affordable prices. We work with Medicare, Aetna, AV-MED, CarePlus Florida, Cigna, CMS, Humana, Medica HealthCare, Preferred Care Partners, UMR, United HealthCare, and many more.
Call A Fitting Experience Mastectomy Shoppe For Fast and Easy Insurance Claims
Health insurance claims can be complicated, and we want you to feel relaxed and confident to help you heal after your mastectomy. Our skilled office personnel are highly qualified with years of experience to handle all your insurance needs. We welcome you to call us for further information at (754) 666-4311.