Are Post Mastectomy Camisoles Covered by Insurance?

May 13, 19

If you are looking into supplementing your post-mastectomy wardrobe with a post-mastectomy camisole, you may be wondering: Will my insurance cover my post-mastectomy camisole purchase?

The answer to that question is fairly straightforward, with a few exceptions: Most insurance companies will cover the cost of breast prosthesis and post-mastectomy garments, including mastectomy camisoles.

However, there may be some extenuating circumstance and clauses in your coverage that make obtaining that coverage a little bit more convoluted.

The following is a guide to help you determine what is covered, what isn’t covered, and what to look for as well as where to look in your health insurance to find out which mastectomy garments are covered by your insurance company.

Medicare coverage

Medicare coverage sets the guidelines for what is and is not covered by health insurance. According to these guidelines, partial reimbursement can be granted for four to six mastectomy bras annually, and three medically necessary camisoles per month.

However, additional bras or camisoles may be prescribed by your doctor if you experience significant weight gain or loss after surgery.

Typically, your insurance is also required to cover these additional garment prescriptions, though the mastectomy camisole purchased must meet certain standards, such as the inclusion of pockets for breast prosthesis, in order to be covered by Medicare.

Private insurance coverage

Similar rules generally apply to private insurance, and the only major difference may be the number of post-surgical bras, or mastectomy camisoles that are covered by your plan, as well as the amount reimbursed for each product.

It is important to contact your insurance agent or company to verify your exact benefits before scheduling a fitting to ensure t you are looking at the correct products from the start of your fitting.

Talk to your certified fitter about which products your policy covers, how many garments are permitted annually, and how much is reimbursed for different pieces. With this information, a certified fitter can help you find and fit clothing in your price and product range that will round out your wardrobe and cater to your needs.

What you need from your doctor

It is important to obtain a prescription from your doctor for your mastectomy garments in order to then obtain reimbursement for your mastectomy-wear costs.

Before going in for a fitting or purchasing anything you need, check with your insurance provider and determine exactly what is covered. Some private insurances will only sell specific items under every mastectomy garment brand, which makes finding high-quality garments that fit you well and last all the more important.

If this sounds intimidating, don’t worry! Your doctor’s office and certified fitter will be familiar with reimbursement procedures from different insurance providers, and they should be able to help walk you through and provide all the information you need on your prescription.

Reimbursements

In order to obtain your reimbursement, you will likely have to provide most if not all of the following items to your insurance company:

* A written diagnosis from your physician.

* A prescription from your physician for post-surgery bras, breast prosthesis, or mastectomy camisoles.

* A copy of your receipt from the mastectomy store.

* A printed copy of the reimbursement form from your insurance provider.

However, it may also be the case that your insurance requires pre-authorization of products, so it is always best to check with an insurance agent before attending your fitting.

Once your paperwork is submitted, your claim can take anywhere between 30-120 days to process, though most companies process claims fairly quickly.

How much is covered?

The amount that is reimbursed can vary drastically from plan to plan, as some insurers will offer full coverage while others will only reimburse a percentage of your costs. Still, others even work on a lump-sum basis and provide a pre-determined sum that can be used at your discretion.

The takeaway

In short, looking into your plan is the best way to ensure your mastectomy camisole purchase is covered by your insurance.

Keep in mind that, if your doctor provides you with a prescription for mastectomy wear, it is likely that you are entitled to mastectomy camisoles as a necessary garment for the recovery process and never hesitate to call your insurance provider, your physician, or your certified fitter with any questions regarding what is covered by your specific insurance policy.

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