What you need to know about
your Medical Coverage
So many women remember the day they were told they had breast cancer as an ending. A day that took something away from themselves and their self-esteem. It doesn’t have to be. Because you are still the vibrant woman you’ve been your entire life.
You have breast cancer now what do I need to? The more information you have the more in control you will feel.
Step 1 Scream, yell and vent, tell everyone or no one. I do recommend telling someone that can support you through this difficult time, someone that can help you with appointments and information “overflow.”
Step 2 Call your insurance company: Ask them to go over your coverage, do you need a doctor’s prescription, how many bras and forms do they cover under your insurance program?
A Fitting Place is an in-network provider with most major insurance carriers, including Medicare.
AFP is a Medicare accredited facility.
Each policy will have its own criteria of coverage. Medicare allows you to have a post-op camisole that assists you with drain management right after surgery, up to 6 bras a year, weighted silicone forms every two years and a non-weighted form every 6 months if needed. Other insurances may only allow for one to three bras a year, every policy must allow for post-op camisoles, weighted & non- weight forms. For more information on your rights after a mastectomy log onto: www.cancer.org
You have breast cancer now what do I need to? The more information you have the more in control you will feel.
Step 1 Scream, yell and vent, tell everyone or no one. I do recommend telling someone that can support you through this difficult time, someone that can help you with appointments and information “overflow.”
Step 2 Call your insurance company: Ask them to go over your coverage, do you need a doctor’s prescription, how many bras and forms do they cover under your insurance program?
A Fitting Place is an in-network provider with most major insurance carriers, including Medicare.
AFP is a Medicare accredited facility.
• AFP will file your primary and crossover claims for you. It is the responsibility of the client to know their insurance coverage criteria, co-pays and deductibles. You will not owe AFP unless you have a deductible or co-pay that has not been met at the time of your visit.The Women’s Health and Cancer Rights Act of 1998, WHCRA, mandates that every insurance policy allows coverage for post-op mastectomy bras and forms. Mastectomy benefits may have a yearly deductible and may require that you pay co-insurance. Co-insurance is when health costs are insured for less than the full amount and the patient must pay the difference. For instance, the company may cover 80% of your expenses after you pay the deductible, leaving you to pay the other 20%. This 20% is also called a co-payment or co-pay. But any required deductible and co-insurance must be like those the plan uses for other conditions it covers. So, if a plan pays 80% for hospital and surgery fees for an appendectomy, but only 70% of hospital and surgery fees for breast reconstruction, that would violate the WHCRA.
• Mastectomy benefits may have a yearly deductible and may require that you pay co-insurance. Co-insurance is when health costs are insured for less than the full amount and the patient must pay the difference. For instance, the company may cover 80% of your expenses after you pay the deductible, leaving you to pay the other 20%. This 20% is also called a co-payment or co-pay. All Co-pays, office visits, and deductibles will be collected at the time of your visit
Each policy will have its own criteria of coverage. Medicare allows you to have a post-op camisole that assists you with drain management right after surgery, up to 6 bras a year, weighted silicone forms every two years and a non-weighted form every 6 months if needed. Other insurances may only allow for one to three bras a year, every policy must allow for post-op camisoles, weighted & non- weight forms. For more information on your rights after a mastectomy log onto: www.cancer.org
Did you know? All providers of mastectomy forms and apparel that are under contract with an insurance company are mandated to accept the insurance carriers contracted amount, giving you the best price available. The allowed amount will not vary from provider to provider. So no need to shop price, we are all priced the same, once we bill the insurance.
HOWEVER: if you chose to wear a form or bra that is above the allowed amount your insurance coverage allows this is considered an upgrade and you will be responsible for that up-grade price. An example of an upgrade is: if insurance allows coverage for a standard bra, no frills, no extra features and you want a bra with additional features like a camisole bra or front and back closures, extra padding, seamless etc. you will be asked to pay an upgrade above the standard coverage. This does not excuse the co-pays and or deductibles associated with your coverage criteria, the upgrade and co-pay/deductibles if applicable will be collected at the time of service. You will be given an upgrade waiver to sign detailing why you are paying for these additional features, so no surprises!
A FITTING PLACE IS PROUD TO HAVE BEEN ACCEPTED AS THE ONLY PROVIDER FOR CRANIAL PROSTHETICS, (WIGS) IN THE STATE OF MINNESOTA.
Make this a good experience for yourself. This is not the time to skimp on yourself but rather an opportunity to be the best you can be under such stressful times. You have always cared about how you look so don’t short change yourself now. You will be wearing your wig for 12 to 18 months as your hair re-growth can be very slow. Ask yourself “how much have I spent on my hair care, color cuts plus hair care products in 18 months?” There’s your budget, you would have spent it anyway. A good wig is the difference between loving the way you look or tolerating the condition you have and hating to look in a mirror.
HOWEVER: if you chose to wear a form or bra that is above the allowed amount your insurance coverage allows this is considered an upgrade and you will be responsible for that up-grade price. An example of an upgrade is: if insurance allows coverage for a standard bra, no frills, no extra features and you want a bra with additional features like a camisole bra or front and back closures, extra padding, seamless etc. you will be asked to pay an upgrade above the standard coverage. This does not excuse the co-pays and or deductibles associated with your coverage criteria, the upgrade and co-pay/deductibles if applicable will be collected at the time of service. You will be given an upgrade waiver to sign detailing why you are paying for these additional features, so no surprises!
A FITTING PLACE IS PROUD TO HAVE BEEN ACCEPTED AS THE ONLY PROVIDER FOR CRANIAL PROSTHETICS, (WIGS) IN THE STATE OF MINNESOTA.
Make this a good experience for yourself. This is not the time to skimp on yourself but rather an opportunity to be the best you can be under such stressful times. You have always cared about how you look so don’t short change yourself now. You will be wearing your wig for 12 to 18 months as your hair re-growth can be very slow. Ask yourself “how much have I spent on my hair care, color cuts plus hair care products in 18 months?” There’s your budget, you would have spent it anyway. A good wig is the difference between loving the way you look or tolerating the condition you have and hating to look in a mirror.
You have been told you will lose your hair during your chemotherapy treatment, now you are really upset and have so many fears and questions. Relax and know you are in good hands at A Fitting Place. We have over 40 years experience with this situation and we will take you through the process and bill your insurance for you if you have coverage. One big thing to remember is this is not going to be your grandmother’s hair, or that woman you see in the mall with the helmet head. Our wigs are so fantastic that most women tell us they have never looked better, everyday is a good hair day with a good wig.
Frequently Asked Questions about your insurance coverage for cranial prosthetics (wigs).
Do all insurance policies cover a wig?
Frequently Asked Questions about your insurance coverage for cranial prosthetics (wigs).
Do all insurance policies cover a wig?
No.Is chemotherapy induced hair-loss the same as Alopecia Areata?
• Medicare never pays for wigs
• If you live in MN and have a MN based carrier it is a mandated coverage for alopecia areata.
• What is Alopecia Areata?—A possibly autoimmune disorder that causes patchy hair loss that can range from diffuse thinning to extensive areas of baldness with "islands" of retained hair. Medical examination is necessary to establish a diagnosis.
No, this is a medically induced hair-loss not an autoimmune disorder.How do I know if I have this coverage?
Call your customer service representative and tell them the reason for your hair-loss, chemotherapy, alopecia, thyroid etc. and they will be able to tell you if you have this coverage.My doctor wrote a prescription will my insurance company have to pay for it?
No, the prescription is only stating you are entitled to a wig due to a medical condition. This “condition” must be covered or allowed under your policy guidelines. However if your policy does cover this product we will need the RX for our records.Will my insurance cover any wig I chose regardless of cost?
Your policy will have a maximum allowable that they pay for this product. Your customer service representative will be able to tell you this amount according to your policy. If you chose a cranial prosthetic or wig that is more expensive then the allowed amount you will be responsible for the up-grade price. This up-grade will be paid to AFP and does not apply to any deductibles or co-pays. If your policy has a deductible or co-pay you will owe that in addition to the up-grade amount.Does insurance pay for everything I will need?
Insurance will only pay for the wig. The support products and turbans are not covered. AFP offers complementary shaping of your wig. However if it needs alterations or extensive cutting this is not included in the cost of the wig and may be your responsibility.What if I buy a wig and I don’t like it?
Please choose your wig carefully, there are neither refunds nor returns on wigs. You will be scheduled for a consultation where you will select the wig of your choice; we make every attempt to match cranial measurements, your hair color and style. Once you have decided on a wig and it is customized to match your styling requirements it is your wig.What if I don’t use up my allowed amount can I get a second wig?
Your insurance customer service person will know if your coverage is for one per year, one per life time or if you can buy as many as you want up to the allowed amount.
