Insurance & Reimbursement

If you are thinking “I don’t want a medical looking bra,” or "I don’t want a hot and sticky breast form,” there’s no need to worry. You can find lacy, feminine, comfortable bras for everyday and for sports. 

As for hot and sticky, breast forms like our Energy breast forms can keep that at bay. They equalize temperature with innovative Comfort+, storing excess heat from your chest wall. The Amoena Energy forms also feature air flow pearls that create channels for optimum air circulation, making the skin feel pleasantly dry all day, every day. 

Medicare guidelines

Medicare guidelines deem the useful lifetime expectancy of a silicone breast form is two (2) years, and a non-silicone form has an expected lifetime of six (6) months. However, if there is a change in your medical condition necessitating a different type of item, it must be documented by your physician submitting a new prescription which explains the need for a different type of breast form.

Of course, you can always replace your breast form yourself, if you lose it or it gets damaged, but this cost may not be covered. 

How insurance works for breast forms

You can explore and learn about our breast care products here on the Amoena website. Then, locate an Amoena retailer close to you. Call the retailer of your choice and determine if she is knowledgeable about your insurance. 

If you are covered by Medicare, be sure the retailer has a Medicare Supplier Number. The retailer may choose to handle your purchase in one of two ways. It is important to ask if she accepts Medicare assignment or does not accept Medicare assignment. Below, is a description between the two Medicare statuses. 

1. They may not take assignment and request payment from you in full, and then bill your insurance or Medicare on your behalf so that the reimbursement check comes to you. 
2. Or they may accept assignment. This will allow you to take the form without full payment, while the store files for direct reimbursement. In most cases, you will be expected to pay your insurance deductible/coinsurance responsibility. Amoena retailers are there to help you determine what’s covered by your health insurance and what’s not. 

The fitter's desire is to help you find the right products for you. 

Help for those in need 

Many foundations offer financial assistance for the uninsured or underserved. Note that each organization requires an application, and all grants are subject to eligibility verification.

• American Cancer Society / 800-ACS-2345 / http://www.cancer.org/ -- Referrals for financial assistance; some local offices provide transportation assistance, temporary housing, wig, prostheses, bras, or prescription assistance.
• CancerCare / 800-813-HOPE / http://www.cancercare.org/ -- Financial grants available for transportation, homecare, childcare and pain medications. Linking Arms Program can provide grants for breast cancer patients to help with selected supply costs.
• Patient Advocate Foundation / 866-512-3861 toll-free / -- Provides direct co-pay assistance for pharmaceutical products to insured breast cancer patients (including Medicare Part D beneficiaries) who financially and medically qualify. 

Search locally and within your state to find other assistance organizations, if you are in financial distress about your medical expenses.

More information about breast forms, bras and insurance is here.

Note: Amoena does not process insurance if you purchase bras online through this website. Visit our FAQs.

Adapted from Breast Cancer Wellness magazine, Winter 2008.