Are Mastectomy Bras Covered by Insurance?
For individuals who have undergone a mastectomy, finding the right post-surgical garments, such as mastectomy bras, is vital for improving comfort, support, and confidence. However, the cost of these specialized bras can add up, leading many to wonder: Are mastectomy bras covered by insurance?
The answer is often yes, but the coverage varies depending on the insurance provider, policy details, bra type, and location. In this post, you will learn more about how insurances treat mastectomy bra coverage.
The Importance of Post-Mastectomy Bras
Post-mastectomy bras are specially designed undergarments that provide support and accommodate breast prostheses for individuals who have had a mastectomy, lumpectomy, or other breast surgeries. These bras typically feature pockets for breast forms, wider straps for added comfort, and are made from premium, soft materials to help prevent irritation.
The truth is, mastectomy bras, like AnaOno’s Carrie Pocketed Lace Molded Cup Bra, are much more than just a clothing item; they play a crucial role in one’s post-surgical recovery, their physical comfort, and their emotional well-being.
How Insurance Coverage Works for Mastectomy Bras
Under the Women’s Health and Cancer Rights Act (WHCRA) of 1998, insurance providers that cover mastectomies must also cover post-mastectomy reconstructive surgery, breast prostheses, and mastectomy bras. This federal law ensures that individuals who have undergone a mastectomy receive the necessary medical garments and devices without discrimination.
However, specific coverage levels depend on individual insurance plans, and in most cases certain conditions must be met before the insurance company will approve coverage. For instance, most insurance providers will cover ONLY L8000 mastectomy bras, like AnaOno’s Rora Pocketed Front Closure Bra, and ONLY after the surgery has been performed. An L8000 bra is one with pockets that are intended to hold a mastectomy form or breast prosthesis held adjacent to the chest wall. Bras coded L8000 do not include an integrated breast prosthesis.
The following is a review of how insurance coverage works for post-mastectomy bras.
Medicare Coverage
Medicare provides coverage for mastectomy bras under Part B (Durable Medical Equipment - DME) as long as they are deemed medically necessary. Generally, Medicare covers:
- Up to four mastectomy bras per year (with potential for more if medically justified by a doctor)
- Breast protheses, including silicone and non-silicone options
- Partial prostheses for lumpectomy patients, and reconstruction patients
To qualify for coverage, the patient must have a prescription from their doctor, and the supplier must be Medicare-approved. Patients typically pay 20% of the Medicare-approved amount, while Medicare covers the remaining 80%, after the Part B deductible is met.
Private Insurance Coverage
Most private insurance plans follow Medicare’s guidelines but some may offer additional coverage. The extent of coverage depends on the insurance provider and the patient’s specific policy. Many private insurers cover:
- Multiple mastectomy bras per year
- Custom-fitted prosthetics and breast prostheses
- Additional bras beyond the standard coverage with medical justification
If you have private health insurance, then it’s essential to check with your insurance provider to understand their specific requirements, including whether a prescription or prior authorization might be necessary.
Medicaid Coverage
Medicaid coverage for mastectomy bras varies by state. Some state Medicaid programs fully cover mastectomy bras, while others may require copayments or limit the number of bras a patient can be eligible for annually. As a result, if you have Medicaid, then you should contact your state Medicaid office for details on eligibility and coverage limits.
How to Get Insurance Coverage for Mastectomy Bras
Step 1: Obtain a Prescription: Most insurance companies will require a prescription from a healthcare provider stating that mastectomy bras are a medical necessity. The prescription should specify the type and number of bras needed. To qualify for coverage, the prescription needs to be written for L8000 mastectomy bras.
Step 2: Verify Insurance Benefits: Before purchasing your mastectomy bras, contact your insurance provider to confirm coverage details, including:
- The number of bras covered annually
- Any copayments or deductibles
- Whether prior authorization is required
- Approved suppliers or durable medical equipment (DME) providers
Step 3: Purchase from an Approved Supplier: Insurance providers typically have a network of approved mastectomy bra suppliers. Some specialty stores, medical supply companies, and online retailers are accredited by insurance companies and can bill them directly.
Step 4: Submit a Claim if Needed: If purchasing from an out-of-network provider, you may need to pay upfront and submit a reimbursement claim. Keep copies of receipts and any necessary documentation required by your insurance company. If you purchase your mastectomy bra from AnaOno, then you can simply send your insurance provider a copy of your order confirmation email. Your order confirmation email includes all of the necessary information that is needed for your insurance provider to process your reimbursement, such as our NPI number, our address, and L8000 printed on the confirmation. If you need your email confirmation re-sent or if you run into any problems or have any questions please reach out to our insurance experts at cs@anaono.com.
What If Insurance Denies Your Mastectomy Bras?
If your insurance provider denies coverage, then you can consider the following options:
- File an appeal: Request a review of the decision and provide additional medical justification from your doctor.
- Seek financial assistance: Some nonprofit organizations and foundations provide mastectomy bras at reduced costs or free of charge.
- Check manufacturer assistance program: Some mastectomy bra brands offer discounts or assistance programs for individuals without coverage.
- Ask if the manufacturer accepts FSA/HSA payments: Both flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) allow you to set aside pre-tax money for eligible medical expenses, which can include post-mastectomy bras.
Don’t Underestimate the Importance of Having a Mastectomy Bra
Don't underestimate the importance of wearing a surgical bra after your mastectomy. Your bra will be a crucial part of your recovery process. It will not only help you feel more comfortable, but it will also help improve your sense of well-being and your confidence.
At AnaOno, we believe that insurance coverage for post-surgical bras should be an instant approval, but unfortunately, approvals are not always easy and straightforward. That’s why we offer several pathways in which you can get the surgical bra you need to recover.
For one, we accept FSA/HSA payments. We also have a Bra Assistance Program, in which we have partnered with Pink Warrior Advocates to provide patients in need with a donated bra, should their finances not allow them to purchase one. Our Bra Assistance Program is powered by Pink Warrior Advocates, sponsored by PRMA Plastic Surgery, and provided by generous AnaOno customers. And we offer several L8000 mastectomy bras to choose from, including the best-selling Monica Full Coverage Bra, for those whose insurance provides coverage.
AnaOno is fully committed to helping mastectomy patients find the post-surgery bras they need to recover quickly, comfortably, and properly. If you need help finding a mastectomy bra that your insurance should cover, just give us a call at 866-879-1744, or leave us a message online, and one of our bra specialists will quickly respond to your request.
