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Insurance Sun Medical

Mastectomy Bra Insurance Coverage and Reimbursement

Wait! Bra's might be covered by my health insurance?

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.

We are always here to help you find something comfortable and make this experience as calming and supportive as we can, so you can focus on healing. Since we know a lot about lingerie, we want to be sure to stick to what we are good at. That’s why we’ve teamed up with SunMED Medical Solutions to help you process your coverage and claims.

Fill out the eligibility form below to check your coverage to see what is available to you. A certified mastectomy fitter will be in touch to review your benefits.

We know you may have some questions about the process to get your AnaOno bras covered. Here’s what you need to know and tips to help you get started.

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. With that in mind, beautiful and supportive mastectomy and post-surgery bras and forms may be eligible to be covered by insurance. 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 cs@anaono.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

  1. Prescription (don't forget your diagnosis code, or download our form to take with you to your next appointment)
  2. Insurance info (always in your wallet)
  3. Ordering Physicians contact info (got ‘em on speed dial, we know)
  4. Fill out our (only takes about 5 minutes!)

HEADING TO THE DOCTOR?

Have any questions? Please contact us at cs@anaono.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.

FAQ: INSURANCE COVERAGE

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.

Is there a limit on how many bras I can get?

Generally, most insurance companies allow 4-6 bras per year. You can ask the person in charge of running your claim about the exact number allowed by your insurer.

What if I’ve had reconstruction?

Reconstruction is not always perfect, and a balance form or other breast prosthesis may be needed. It is important to get your prescription from your surgeon or plastic surgeon for a L8000 coded pocketed mastectomy bra and apply to check your coverage.

Am I eligible for post-mastectomy bra coverage without reconstruction?

Yes, you are. Your doctor or surgeon can write a prescription for a L8000 pocketed mastectomy bra and you can apply to check your coverage.

What styles are included in the L8000 coded pocketed mastectomy bra?

All AnaOno pocketed bra styles are eligible for coverage under the L8000 code. You can find these styles by searching for bras with “pocketed” in the name. Or, you can browse our collection of pocketed styles. Please note that other non-pocketed styles are not included in this code.

What doctor can prescribe a L8000 code mastectomy bra for me?

Any doctor within your course of treatment can prescribe your breast forms and mastectomy bras, but we suggest your breast surgeon or plastic surgeon as they are accustomed to writing these prescriptions. Scheduling your doctor’s visit? Download our prescription form here.

Do you have any tips for asking my doctor for the prescription?

Be sure your diagnosis code is written on the prescription as well as the amount of mastectomy bras deemed medically necessary. We recommend asking for a minimum of four bras, that way you don’t have to go back right away for another prescription. Diagnosis codes available on our easy to use prescription form that can be downloaded here.

How long are prescriptions valid?

Once passed to the provider for processing, prescriptions are valid for up to 90 days. That means, you don’t have to make a full commitment on your first order. You can request one bra, check the size, fit, and style, and then order additional bras without needing a new prescription.

How long does it take to process my claim?

Our DME partner processes your intake form in 4-5 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! Contact SunMED directly 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 AnaOno 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.


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 cs@anaono.com or call 866-879-1744 and ask for Lauren.