As your advocate, we will be happy to file your claim with any insurance carrier. We are participating providers with Blue Cross/Blue Shield, BlueMedicare, Medcost, North Carolina Medicaid, Medicare, United Healthcare, Humana.
Currently working on Cigna Aarp, Tricare & ChampVA. For all other carriers, we will be glad to check eligibility & coverage.
Medicare and most private insurance companies will help with the cost of your breast prosthesis and pocketed bras, whether you have had a mastectomy or lumpectomy and regardless of when you had your surgery.
Patients are responsible for all Co-pay and Deductibles as set by and according to your insurance policy, at the time of service and product delivery. Insurance coverage for breast cancer patients is something we advocate; please contact us with any questions about our courtesy claim filing service.
Q: What will I need now that I have had breast surgery?
A: During your healing period we offer post-surgical camisoles designed to hold drain tubes.
After recovery you would be eligible for bras and breast forms. If you had a lumpectomy or a portion of your breast removed, a silicone partial works great to smooth out and create a more symmetrical image. If you have had a mastectomy, an external prosthesis will restore that natural look you had before surgery.
Q: Do you carry a surgical garment that accommodates drain tubes and bulbs?
A: Yes! We carry mastectomy apparel that are designed for comfort and function. The garment features a drainage management system for the Jackson-Pratt, Hemovac systems. This is a great garment to be used immediately after a Mastectomy/Lumpectomy or Reconstruction/Augmentation.
Q: Do I need to make an appointment and if so, how long will I be there?
A: Appointments are recommended. Your initial appointment will take approximately 30 minutes to an hour.
Q: May I bring someone with me?
A: Absolutely! Many bring their daughters, girlfriends, spouses, or daughters-in-law. This is your time and we want it to be an informative and pleasurable visit. You can come alone or bring someone with you; it’s up to you.
Q: Does insurance help cover these products?
A: In most cases, yes. Deductibles and Out-of-pocket applies. Per Women’s Health Care and Cancer Act of 1998, coverage is based on having had a Mastectomy or Lumpectomy. In some cases coverage is also available for failed reconstruction.
For insurance to help with coverage we will need to do a band measurement at least once a year.
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/Prosthestics. As a courtesy, we will contact your insurance carrier even if they are out of network, to determine your eligibility.
We are out-of-network with Aetna and Cigna Healthspring. However, we can file to Aetna as an out-of-network provider. For Cigna Healthspring we can request a pre-authorization to be considered in-network.Q: Do I have to pay a co-pay?A: An estimated copay is determined when benefits are quoted by your insurance carrier. Co-pays, and deductibles if applicable, are required at time of service.
Q: I had lumpectomy surgery some time ago and recently noticed that one side of my bra doesn’t fit well anymore, seems to have more wrinkles. Can anything be done to correct this?
A: Yes! Many times after lumpectomy surgery, women may experience some asymmetry. It may be noticeable right away; sometimes months later; and in some cases, years later! The good news for these women is there is a partial prosthesis, a natural feeling “overlay”, which slips discreetly into the pocket of a mastectomy bra and corrects the symmetry.
Q: I have elected to have reconstruction of one side following a mastectomy. Now I find that my breasts are a noticeably different shape and size, and the reconstructed one is higher up than my natural side. I don’t want to have further surgery and there are no guarantees the problem can be fixed. What can I do?
A: As with lumpectomy patients, you may be a perfect candidate for a partial prosthesis. They come in varying sizes and thicknesses with no more inconvenience than putting on your glasses or contact lenses every day. The method for most reconstruction dictates that the reconstructed breast will have a slightly flattened effect; even if you elect to have your surgeon construct a nipple area after the implant is in place. While visually things look good, retail bras aren’t made to fit this shape; a problem, which sometimes shows through your clothing. Again, Medicare and other insurance plans in most cases cover products if you had a diagnosis of breast cancer.
Q: I had reconstruction years ago. I have lost weight since then and now my reconstructed side is larger than my natural side. What do you recommend?
A: The guidelines for these products state the importance of restoring weight and balance after breast surgery. Sometimes getting that symmetry back means wearing a partial on the unaffected side. Whenever we gain or lose weight, we likely gain or lose breast tissue as well. It’s not uncommon for women to gain or lose down the road from reconstruction and need to do a little “fine-tuning” to get that symmetry back. It’s perfectly acceptable in cases like this to wear a partial on the unaffected side to correct asymmetry.
Q: What if I don’t have insurance?
A: We will help you to explore all possible options. Assistance is also provided by Cancer Services in Forsyth and surrounding counties.
Q: What should I bring?
A: Your most current insurance card(s) and a valid picture ID are needed to file claims to your insurance company. If you have a prescription from your doctor you may bring that as well.
Q: Do you have wigs?
A: Yes! We carry Jon Renau, Envy and Henry Margu.
Q: What type of head coverings do you carry?
A: We carry stylish hats from Dorfman, Betmar, and others. We also carry a fine line of cotton voile, rectangular and square scarves in assorted colors and prints. Sleep caps and hat scarves are also available.