WHAT? My insurance may cover my mastectomy bras (even if I had reconstruction)?
YES! And we are here to help you make sure you get the most out your experience. If you have any questions at all, please contact us at firstname.lastname@example.org or give us a call 866-879-1744 and ask for Kelly, our Insurance Expert!
But while we are at it, we wanted to give you some tips and answer our frequently asked questions. We hope this helps you through the insurance process!
Will my insurance cover bras?
All insurances have programs to cover your surgical bras and post-mastectomy bras, but there could be some limitations. We work with SUNMED, a reputable durable medical equipment supplier. They will take your necessary details and give you a summary of what your insurance covers (and if they have the contract to process your order).
My surgery was 10 years ago, can I still get covered?
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.
How many bras can I get?
Most insurance plans typically allow between 4-6 bras per year, this will vary by provider and medical need. It is always best to have whoever is running your claim ask about restrictions of your coverage.
Are they still covered if I've had reconstruction?
The answer is yes. You just have to receive a prescription from your doctor. Keep in mind that not every reconstruction is perfect. You may need a balance form to fill out any gapping or asymmetry from one breast to the next, and the mastectomy bras that fit the required L8000 code attributes are pocketed for this purpose.
What about no reconstruction?
Absolutely! As long as your surgeon or doctor provides you with the appropriate prescription, you have your choice of pocketed styles (even if you choose not to use them, that’s up to you)!
What styles are included in the L8000 code?
All of our pocketed bras are included in this code. They are easy to pick out; just look for “Pocketed” in the product name or check out the Pocketed collection. Unfortunately, that means that the rest of our products are not covered under this code.
What doctor can prescribe a L8000 mastectomy bra for me?
The answer is any doctor, but we suggest your breast surgeon or plastic surgeon as they are commonly used to writing these prescriptions.
Do you have any tips for asking my doctor for the prescription?
Have your diagnosis code handy; don’t forget this! Also, the number of bras needed. We recommend asking for four, that way you don’t have to go back right away for another prescription.
How long are prescriptions valid?
Once passed off to SunMed for processing, prescriptions are valid for up to 90 days. That means, you don’t have to make full commitment on your first order. You can request one bra, check the size, fit, and style, and then reorder your other 3+ without needing a new prescription.
How long does it take to process my claim?
Our DME partner processes your intake form in 2-3 business days. They will contact you by your preferred method: phone, email or text. But if they do not hear from you after you submit your intake form, they may close your inquiry. So be sure to get back to them! There may have been something as simple as a typo, like missing an "i" in gmail when filling out the form. Contact SunMed at 856-552-6955 if you have filled out a claim but have not received a message back. (and don’t forget, we are always here for you too!).
Does my provider matter?
It depends. Medicare & Medicaid may require an upgrade fee to process our bras through the insurance, and this depends on if they are your primary or secondary insurance. SunMed will walk you through all the details that your insurance carrier needs, so you are not in the dark on anything.
If you think you are ready to pick out your bras and take advantage of your insurance benefits, then double check the list below to make sure you have everything you need to get started.
Have all of this ready and you can knock out that form while you finish your morning (or nightly) cup of coffee.
All your contact info
Prescription (don't forget your diagnosis code)
Ordering Physicians contact info (got ‘em on speed dial, we know)
Insurance info (always in your wallet)