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Does insurance cover prosthetics, mastectomy bras, and accessories?

Mastectomy Bras

Mastectomy Bras

Surgical procedures used to treat breast cancer, such as lumpectomy or mastectomy, often cause changes that can result in breast asymmetry or absence of the breast all together. There are many amazing products available that are designed to help patients achieve symmetry after these breast cancer surgeries. Recently, I had the pleasure of talking to Rachel Brown at Over My Head Boutique located in the OhioHealth Bing Cancer Center in Columbus, Ohio about this very topic. I was very pleasantly surprised when I learned that most insurance plans provide coverage for these very important and often necessary adjuncts to the reconstructive process. Rachel kindly provided me with the following information.

Facts on insurance benefits and products available to reconstruction patients:

 

• It is federally mandated that insurance covers BOTH reconstruction and prosthetics. In other words, insurance cannot legally deny coverage for prosthetics, mastectomy bras and accessories which may or may not be needed after reconstructive surgery. This is outlined in the Women’s Health and Cancer Care Act of 1998.

 

• Many special post-operative garments are available, and billable to insurance. These often include drain bulb holders, vitamin infused cotton, padding for symmetry, front closures and various degrees of compression and support.

 

• Semi-custom prosthetic nipples are a very helpful product for many women undergoing reconstruction. They can be adhered with water or silicone based adhesives, and may aid in making a decisions on size and color when considering nipple tattoos/reconstruction.

 

• Many pocketed bras are useful following reconstruction, as they can hold in place a push up pad to lift the unaffected breast, or smoothing pads to give a more round, natural breast shape bilaterally.

 

• Patients can call the customer service number on the back of their insurance card to ask a representative about quantities of bras and prosthetics allowed under their specific coverage plan.

 

• Benefits for pocketed bras and breast prosthetics/partial prosthetics are available to a woman her entire life, following a breast cancer diagnosis. This is due to the fact that breast size and shape changes over time, and different products may be needed as the body changes. Typically insurance will cover additional pocketed bras every year, and prosthetics every two years.

About the Author

Ergun Kocak

Dr. Ergun Kocak, MD, MS, is a board-certified plastic surgeon who specializes in plastic and reconstructive surgery of the breast using DIEP, SIEA GAP, TUG, PAP, and direct-to-implant, in Columbus and Cincinnati, OH.
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One thought on “Does insurance cover prosthetics, mastectomy bras, and accessories?”

  1. My mother is about to go into surgery help with her problem. And she was curious if after it is all over, what kind of bras she would need. After looking at this website, pocket bras seem to be very useful as they can hold everything in place really well. I will make sure I let my mom know about this. Thanks a ton!

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