Insurance Coverage on Post-Surgical Bras
The Women's Health and Cancer Rights Act (WHCRA) mandates that most group health plans covering mastectomies must also cover breast reconstruction and related services, which can include post-operative garments like mastectomy bras and prostheses. However, it's important to note that WHCRA does not require all insurance plans to cover mastectomies initially.
The Resilience Bra is coded as L8001 for unilateral procedures and L8002 for bilateral procedures. These codes are commonly used by many insurance companies, but coverage can vary. Each insurance provider has different requirements for reimbursement of post-surgical bras, and coverage typically applies after breast cancer surgery. It’s best to contact your provider to understand your specific coverage, out-of-pocket costs, and the timing of when post-surgical bras will be eligible for coverage.
Coverage Varies by Provider
Private Insurance Coverage
Many commercial insurance companies model their policies after Medicare, although some offer broader benefits. Coverage varies from plan to plan, but may include more than four mastectomy bras annually and additional bras when a medical provider verifies medical necessity.
Since policies differ by insurer, it’s important for patients to confirm requirements with their own insurer, including whether a prescription or prior authorization is needed and what HCPC codes they cover.
Medicare Coverage
Medicare classifies mastectomy bras as Durable Medical Equipment (DME) when they are considered medically necessary. In most cases, Medicare will pay for up to 4 mastectomy bras each year, with more allowed if a physician documents the medical need.
To receive these benefits, patients need a doctor’s prescription and must purchase from a supplier enrolled with Medicare. After meeting their Part B deductible, patients are generally responsible for 20% of the amount Medicare approves, while Medicare pays the remaining 80%.
Medicaid Coverage
Medicaid rules for mastectomy bras are set at the state level. In certain states, Medicaid will cover them in full, while other programs may set limits on the number of bras or require small copayments. Anyone relying on Medicaid should check directly with their state office to understand what their plan allows.
Self-Filing for Insurance Reimbursement
Three Strands Recovery Wear does not directly bill insurance for post-surgical bras. However, some insurance providers will review itemized receipts for reimbursement. If you would like to file a claim for your Resilience Bra purchase, you may request an itemized receipt from us by emailing sales@threestrandsrecoverywear.com.
Please note: submitting a claim to your insurance company does not guarantee reimbursement. Approval depends entirely on your plan’s coverage and requirements. If self-filing is allowed by your provider, the following steps may help:
- Confirm coverage before purchasing. Contact your insurance provider to clarify:
- How many mastectomy bras are covered per year
- Whether copayments or deductibles apply
- If prior authorization is required
- Which HCPCS codes are covered
- What specific documentation is needed for submission
2. Obtain a prescription: Most insurers require a doctor’s prescription indicating that mastectomy bras are medically necessary. The prescription should state the type of bra and number requested.
3. Request an itemized receipt: After your purchase, email sales@threestrandsrecoverywear.com to receive an itemized receipt. Submit this receipt along with your doctor’s prescription and any claim forms required by your insurance plan.
*The information provided is for informational purposes only and does not constitute medical or legal advice. Coverage for post-operative garments varies by insurance provider, and reimbursement is not guaranteed. Please consult your insurance provider and healthcare professional for specific guidance related to your coverage and recovery needs.*
