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.
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. The SunMED representative will verify your benefits.
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. Bras can also be purchased with an FSA or HSA account through our insurance provider partner.
6. If you need a receipt for reimbursement of your AnaOno bra purchase, you can request one at email@example.com, to submit the claim on your own.
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
Prescription (don't forget your diagnosis code, or download our form to take with you to your next appointment)
Insurance info (always in your wallet)
Ordering Physicians contact info (got ‘em on speed dial, we know)
Fill out our online intake form (only takes about 5 minutes!)
HEADING TO THE DOCTOR?
Download our easy prescription handout, print and take to your doctor's office so they can fill out.
Fax to SunMED directly at 800.715.5422 or scan/email to SunMED at firstname.lastname@example.org
Have any questions? Please contact us at email@example.com or give us a call at 866-879-1744 and ask for Lauren, our Insurance Expert! We are always here to help you!
Check out our answers to frequently asked questions below for some extra help and guidance.
Check Your Coverage
Please note, AnaOno LLC will not process any claims on your behalf, all insurance provider information and billing will be direct through SunMED Medical Solutions. We are here to answer any fit question you may have please contact us at firstname.lastname@example.org or call 866-879-1744 and ask for Lauren.