Does Insurance Cover Prosthetics, Mastectomy Bras, and Accessories?

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 altogether. Many excellent products 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 Ohio Health Bing Cancer Center about this very topic. I was very pleasantly surprised when I learned that most health insurance plans provide coverage for these essential and often necessary adjuncts to the reconstructive process.

Rachel provided me with the following information:

Insurance Benefits and Products Available

Photo Credits: liposales.com

Facts on insurance benefits and products available to breast reconstruction patients:

• It is federally mandated that insurance companies cover breast reconstruction and prosthetics. In other words, insurance cannot legally deny coverage for prosthetics, mastectomy bras, and accessories that may or may not be needed after the surgery. This is outlined in the Women’s Health and Cancer Rights 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 beneficial product for many women undergoing reconstruction. They can be adhered with water or silicone-based adhesives and may help make decisions on size and color when considering nipple tattoos or reconstruction.
• Many pocketed bras help reconstruct, as they can hold in place a push-up pad to lift the unaffected healthy 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 because breast size and shape change over time, and different products may be needed as the body changes. Typically insurance will cover other pocketed bras every year and prosthetics every two years.