After a mastectomy, custom breast forms can help you regain your confidence and become comfortable in your body. But how do you know if your insurance will cover your new custom breast forms?
Upon undergoing a mastectomy, a big priority for some women is feeling comfortable in their new body. To accomplish this, you can choose custom breast forms that are made to closely resemble your specific anatomy. But women often wonder—are custom breast forms covered by health insurance?
The process of getting breast prostheses covered by insurance seems complicated, since individual health insurance policies vary. But with the right knowledge and approach, you can confidently navigate your health insurance coverage to obtain reimbursements or payments for qualifying medical care on your behalf. Be familiar with a few details about the factors that influence your coverage—these factors help to determine if you can obtain custom breast forms that are partially or fully covered by your health insurance plan.
Federal Law Establishes Insurance Coverage
In 1998, the Women’s Health and Cancer Rights Act established protective measures for patients preparing to undergo a mastectomy. This beneficial act compels insurance companies to cover not only the breast tissue removal surgery, but also the reconstruction or prostheses needed afterward. Any complications arising from the mastectomy are also covered under this guideline.
Although coverage must be offered for the acquisition of custom breast forms, you may still be on the line for deductibles and co-insurance as established by your health insurance plan. To remain in compliance with this law, your insurance company must update you on their exact coverage allowances at the beginning of the calendar year.
Insurance Policy Coverage Varies
Even with the protective federal law in place, insurance policy coverage amounts vary considerably. The coverage differences often pertain to the total number of breast prostheses you can acquire or the timing between their acquisition. Some insurance companies will pay for one custom breast form every year, while others will only allow for the acquisition of one set of prostheses total. Since breast prostheses are recommended to be replaced every few years, check with your insurance to see what your specific plan covers.
Detailed Documentation Can Help
If you are required to pay for the breast prosthesis up-front and collect reimbursement from your health insurance company later on, you must ensure you keep excellent records to receive the total balance owed to you. Keep all medical records and receipts in a dedicated file folder to easily present these documents to the insurance company as needed. Always make copies of the documents and keep the originals when supplying the forms as requested. You can also use the documents for the appeals process if your insurance company fails to award the proper amount for your breast prosthesis insurance coverage.
Acquiring Custom Breast Forms After a Mastectomy
If you have undergone a bilateral mastectomy, a unilateral mastectomy, or a lumpectomy, contact ContourMed at 877-380-8528 for assistance with obtaining custom breast forms. With just a single call, you can receive the support you need for the acquisition of breast forms customized for your figure and preferences. With our patented scanning technology, we strive to create breast forms that resemble the slope, drape, and weight of your natural breast tissue.