Book Fitter Appointment


Book Fitter Appointment

    Are All Mastectomy Products Covered by Insurance?

    The Women’s Health and Cancer Rights Act of 1998 (WHCRA) offers protection for mastectomy patients for any type of breast cancer surgery or reconstruction. It ensures that insurance companies cover the cost of a variety of necessary mastectomy products, including breast forms, mastectomy bras, and post-surgical compression bras.

    Whether you have Medicare, Medicaid, or private health insurance, all have insurance plans that are designed to facilitate a fast and comfortable recovery. However, there may be limitations to what you can claim.

    Most standard insurance covers between 4-6 post-surgery bras each year, depending on your provider, level of coverage, and medical needs. The style of bra also impacts your eligibility for coverage. Most providers only allow claims on pocketed post-mastectomy bras.

    Claims on a mastectomy bra are typically not processed until after your surgery. We suggest coming in for a professional bra and breast form-fitting at 4-6 weeks after your mastectomy to allow for post-surgical swelling to subside and the site to heal properly.

    Claims on a mastectomy bra are typically not processed until after your surgery. We suggest coming in for a professional bra and breast form-fitting at 4-6 weeks after your mastectomy to allow for post-surgical swelling to subside and the site to heal properly.

    Suppose you require a new breast prosthesis or bra due to loss, damage, or weight fluctuations. In that case, you may be able to purchase and claim additional products if you obtain a prescription from your doctor, deeming them medically necessary.

    Most insurance companies will cover between 80-100% of the cost for your full cranial prosthesis and will allow you to receive one cranial prosthesis per year for medical hair loss. Depending on your insurance, your prosthesis may also be a tax-deductible medical expense. Compression garments are often necessary after extensive breast surgery and lymph node removal to prevent lymphedema. Unfortunately, Medicare does not provide coverage for compression sleeves or tights. However, you may be eligible for a compression vest, bra, or chest belt under your current plan.

    What Exactly Does Most Insurances Cover

    Insurance plans vary and your out of pocket expense will depend of if your deductible and out of pocket maximum is met.

    Most Insurances Cover
    Items Features and Options Frequency Medical Necessity Requirements
    Breast Prothesis
    Comes Off the Shelf or Custom Medical Grade Silicone or Non-Silicone OptionsOverlays (lay over an existing Breast) Adapt Air (Pump Air into the Prothesis Insurance Bi-Annually Non-sil ever 6 months Significant weight loss or gain
    • Diagnosis Codes should always include Breast Cancer
    • Custom Prothesis: Recommended for concaved chest walls , this requires Special Form Signedform Oncologist (we will supply)
    Mastectomy Bras
    • Seamless, Molded Cup, Strapless, Front Closure
    • Camisoles
    • Sport Bras
    • Compressions
    • Swimwear (not covered by Insurance)
    • 2 to 6 yearly
    • Outside Medicare/Medicaid can
    • only dispense 2 per visit
    Breast Cancer Patient Eligible for LifetimeCoverage
    • Lumpectomy
    • Bilateral or Double Mastectomy
    • Reconstruction
    Post Surgical Garments
    • Compression Bras
    • Drain Systems
    • Puffs
    • Belts
    • After Surgery 2 Compression Bras
    • Fit before Surgery so its available same day as surgery
    • Belts to hold drains
    • Cranial Prosthesis Wigs | Medical Wigs
    • Yearly
    • Requires a Doctor Prescription
    • Alopecia or COVID are also Medical Reasons
    Upper/Lower Extremities Compression
    • Compression (Upper and Lower Compression)
    • Off the Shelf or Custom Options
    • Sleeve
    • Gloves
    • Gauntlets
    • Varies Depending on the garment
    • Insurance cover Certain Brands
    • (Thera-firm , Medi and some Juzo)
    • Most Compression Garments are out of pocket expenses cost range ($100s - $1000s)
    • Complex Insurance Sometimes Require Medical Notes
    • Occupational Therapist in most cases CAN NOT write a referral or prescription

    We Are in-Network With Major Insurance Providers

    We are preferred providers (In-network) with most major carriers including Medicare, North Carolina Medicaid, BlueCross/Blue Shield (HMO, PPO, Federal, North Carolina and most out-of-state plans), BlueMedicare, Cigna Medcost, United HealthCare, Aarp, Humana, Tricare and ChampVA. We will contact your carrier to explore what benefits you have toward Durable Medical Equipment/Prosthetics. As a courtesy, we will contact your insurance carrier even if they are out of network, to determine your eligibility.

    Any insurance that we are out-of-network with we can usually request a pre-authorization or gap exception to be considered in-network.

    We Accept Your Insurance Online!

    You don’t have to pay upfront for the amount your insurance will cover because your insurance will directly pay Survivor Friendly. If you shop with us online (everything except prosthesis), create a telehealth visit so we can ensure the bra you are purchasing is the right fit. You can add your insurance information at the time of the virtual appointment.

    *Please note that whether you shop with us online, or in one of our boutiques, you will always be responsible for your deductible, your co-insurance, and for items, your plan deems not medically necessary or that are not covered by your plan. Medicare, Medicaid, and most insurance companies require an RX for them to make payment. We will notify you if we are unable to obtain an RX on your behalf. Should you have any questions

    Please Call Us at (919) 747-9336