Yes, in most cases. If you have had a lumpectomy or mastectomy, most insurance plans, including Medicare and Medicaid, will cover mastectomy bras and a silicone breast prosthesis, no matter how long ago your surgery was. You will need a valid prescription on file, and depending on your plan, there are limits on how often you can replace each item.
After surgery, billing should not be another burden
After surgery, you need and deserve a little pampering, not extra frustration over paperwork. At Confidentially Yours we work directly with your insurance for billing and payment, so getting properly fitted does not turn into a second job on top of recovery.
It does not matter how long ago your surgery was
One of the most common misunderstandings we hear is that coverage only applies right after surgery. It does not. Whether your surgery was last year or twenty years ago, most insurance plans will still cover mastectomy bras and a silicone prosthesis if you had a lumpectomy or mastectomy. There is no expiration date on that coverage tied to the surgery itself.
The prescription you will need
Every insurance plan requires a valid prescription on file before it will cover these items.
- The prescription can come from your primary care physician or your oncologist.
- Signed prescriptions are valid for one year.
- If you are not sure whether you already have one on file with us, call the store and we will check for you.
Medicare and Medicare Advantage
Medicare and most Medicare Advantage plans cover three mastectomy bras every three months, along with a new silicone prosthesis every two years. This is a set allowance rather than something you need to request each time, though you still need the valid prescription on file.
Medicaid
Medicaid plans allow four mastectomy bras per year, broken down as two bras every 180 days, and also cover a new silicone prosthesis every two years.
Commercial insurance
Commercial plans vary in how many mastectomy bras they cover, so call us and we will verify your specific benefits before your appointment rather than guess based on what another plan allows. Most commercial plans do allow a new silicone prosthesis every two years. We are in network with most insurances, and if there is any question about our network status with your plan, we will confirm it and handle any required steps before your visit.
If your weight has changed
A significant weight change can make you eligible to replace your silicone prosthesis ahead of the usual two-year schedule. This requires clinical notes from your primary care physician or oncologist confirming the change, so reach out to us if this applies to you and we can talk through what is needed.
What you might still owe
We accept most insurance assignments and handle the billing directly with your insurance company, but you may still be responsible for a deductible or coinsurance depending on your plan. Our goal is for you to have properly sized bras and forms that fit your unique shape, without a billing surprise waiting at the counter after everything else you have been through.
Experienced, certified fitters handle every claim
The person walking you through sizing is also the person who understands the paperwork behind it. Confidentially Yours holds the American Board of Certification (ABC) Facility Accreditation, and our fitters are experienced and certified, and that same attention carries over into how carefully we check coverage before ordering anything on your behalf, so you are not left guessing what your plan will or will not pay for.
Getting started
If you would like us to verify your specific coverage before you come in, call (217) 366-0244 and we will check it for you ahead of your appointment. Read more on our insurance and billing page, browse post-breast-surgery bras and forms, or look at our pocketed styles designed to hold a form securely.