Medicare & Personal Insurance Benefits

Insurance and insurance claims are one of the last things that you want to deal with during breast cancer treatment and recovery, but it is important to be informed about what parts of your treatment plan are covered by insurance.  Many of my patients aren’t aware of the extent of coverage for prostheses and bras that their personal medical insurance, Medicare, or Medicaid will cover.  At Scarlet’s Unmentionables, I’m here to help you understand the insurance allocations and know exactly which products are covered under your insurance plan. The challenge with insurance is that different plans from personal insurance, Medicare, and Medicaid allow different types of coverage, so it can be hard to understand what is allowed and what isn’t.  Cheryl will work directly with your insurance company to understand your coverage and share that information with you. However, it is strongly encouraged that you contact your insurance company prior to your visit to fully understand your personal policy.   (The following codes will help your insurance understand what you are interested in purchasing:  L8000 mastectomy bras, L8030 breast prosthesis, L8035 custom breast prosthesis, S8424 compression garment.  It is wise, while speaking to your insurance provider, to determine how many units of each of the above codes you are eligible for per year).  I will help you shop within your insurance budget and I will submit your claims directly for you.

Any deductible or co-insurance will be collected at time of final fitting.

Another piece of understanding insurance coverage is knowing when you’re eligible for re-fitting and new bras or prostheses. Once I have an understanding of your insurance coverage, I will keep track of the benefits schedule and provide you with reminders so you know when you can add or replace items in your wardrobe with insurance coverage.

Insurance FAQs

Q? Are all products covered by insurance?
A. Camisole’s and swimsuits/swim forms are considered not medically necessary and therefore not covered by insurance.

Q? Will insurance cover my breast form?
A. Most insurance companies have a provision for coverage for your breast form, more formally called an external breast prosthesis. Scarlet’s Unmentionables will be happy to verify your coverage with your insurance company, Medicare or Medicaid.

Q? Will insurance cover my bra?
A. Insurance companies, Medicare and Medicaid will typically cover the bra to hold and position the breast prosthesis is you have obtained a breast prosthesis.

Q? Is there any cost to me?
A. Your normal insurance deductibles and co-pays will apply and will be collected at time of final fitting. If you choose an “upgraded” product, you will have to pay the portion that represents the upgrade.  Please see above information regarding contacting your insurance for benefit information.   Scarlet’s Unmentionables will bill your insurance company on your behalf.

Q? How often or how many or prosthesis and bras can I get?
A. This varies by insurance company and is based on medical necessity. Scarlet’s Unmentionables will contact your insurance company to obtain information on your specific policy and their guidelines for replacement of breast prosthesis and bras.

Q? What if I don’t have insurance?
A. Scarlet’s Unmentionables has a program to assist those who don’t have insurance. We feel every woman has the right to feel confident in their appearance as well as assist you to achieve that goal.