Restrictions are not based on WHEN your mastectomy was, but by use and need of a mastectomy bra. All you need is a prescription from your doctor.
Many people who’ve had a single or double mastectomy, with or without reconstruction, don’t know that insurance may cover your purchase of post-surgery bras and mastectomy bras, breast prostheses and breast forms. With a qualifying prescription from your doctor, you may be eligible.
Insurance companies are required to cover your L8000 mastectomy bra AFTER your surgery; however, each insurance provider has different requirements to complete your reimbursement. It is always best to call your personal provider to understand your coverage and any out-of-pocket costs. Don't have coverage in your area? We are able to process any HSA/FSA purchases as well as provide itemized receipts for personal submissions on reimbursement. Email Coverage@AnaOno.com with any questions or requests.. Our insurance experts will be happy to assist you.
If you are not covered by traditional Medicare and are using managed Medicare or a Medicare replacement plan, your coverage will be restricted by the covered states
What You Need to Know
The Women's Health and Cancer Rights Act of 1998 (WHCRA) provides protection to patients who choose to have mastectomy or reconstruction, and for those who choose prosthesis or forms post-surgery. From Medicare and Medicaid, to your private insurance, all insurances have programs to cover your surgical bras and post-mastectomy bras, but there could be some limitations.
1. Most insurance plans typically allow and cover between 4-6 post-surgery bras per year. This will vary by provider and medical need.
2. Only pocketed bras are included in the coverage restrictions set by insurance providers. Check out our super soft pocketed mastectomy bra collection to see which styles work for you.
3. There may be out-of-pocket costs, such as co-pays, upgrade fees, and even additional costs if deductibles are not yet met for the year. Some plans may even require you to pay upfront and receive reimbursement later.
4. Bras are not typically covered until after you’ve had your mastectomy surgery. We recommend waiting 4-6 weeks post-mastectomy surgery to account for any swelling or soreness that may occur immediately following your surgery. If applying before your mastectomy, insurance may decline your submission, and you would need to resubmit your file for processing.
5. If you are not eligible for coverage with your insurance company, bras can be purchased with your HSA of FSA account for 20% off retail. Complete this form, and an AnaOno customer service agent will be in touch with you to confirm your order and payment options within 2-3 business days.
6. If you are located in a state that we are not currently authorized in, you can request a receipt to submit to your private insurance company for reimbursement. This does not guarantee reimbursement, as coverage varies based on insurance companies and plans. To request your receipt, please contact us at firstname.lastname@example.org after you have received your order.
7. AnaOno has partnered with AdaptHealth LLC to process your insurance benefits. An AdaptHealth affiliate will appear on your EOB. Learn more by visiting adapthealth.com/mastectomy.
TOP TIPS FOR APPLYING FOR MASTECTOMY BRA INSURANCE COVERAGE
Bras ARE NOT covered until after your mastectomy surgery. We recommended waiting 4-8 weeks after your mastectomy or reconstruction surgery to apply for your AnaOno bras so the fit will be comfortable and truer to size after healing is complete and swelling has reduced.
Medicare and Medicaid may require a purchase of breast prostheses at time of your bra order, or require that breast forms are being used with a mastectomy bra to ensure coverage.
What about reconstruction? We know that not every reconstruction is perfect. Your insurance may require a purchase of a balance form in your history to ensure mastectomy bra coverage.
Don’t need a breast form? If insurance covers it and the deductible has been met, a breast form can be a useful back-up, just in case.
WHAT YOU NEED PREPARED: APPLICATION CHECKLIST
Completed prescription form (don't forget the diagnosis code). Don't have a prescription? Download one here and bring it to your doctor to complete
Your insurance information (we know it is always in your wallet). You will need to upload a photo of the front and back for verification
Ordering Physician's contact information (you've probably got 'em on speed dial!)
For further assistance please contact us at email@example.com
Check Your Coverage
Please note, AnaOno LLC will not process any claims on your behalf. We are here to answer any fit questions you may have. Please contact us at firstname.lastname@example.org, or call 866-879-1744 and ask for one of our insurance and fit experts.
This program is powered by Adapt Health and their subsidiaries.