Filing Your Insurance Claim

The Women’s Health and Cancer Rights Act (WHCRA) was signed into law on October 21, 1998.  The United States Departments of Labor and Health and Human Services oversee this federal law.  The law applies to group health plans for plan years starting on or after October 1, 1998, and applies to group health plans, health insurance companies, and HMOs, as long as the plan covers medical and surgical costs for mastectomies.

abc-accredit-medIn many instances, your products may be supplied to you at little or no cost!  However, you may be responsible for costs associated with deluxe items, product upgrades, coinsurance amounts or deductibles which may be applicable under your insurance coverage.

Medicare, Medicaid and most private insurance carriers provide the following:

  1. one (1) post-surgical camisole following your surgery;
  2. two (2) foam or fiber leisure forms per surgery side per year, or as medically necessary;
  3. one (1) silicone breast prosthesis per surgery side every two years, or as medically necessary; and
  4. four (4) or more pocketed mastectomy bras per year. *

Be sure to check with your carrier or with Medicare to get additional information regarding your specific benefits.

At present, Medicare and many private insurance carriers do NOT cover swimwear, swim forms, wigs, turbans, etc., although some private carriers have begun offering an “allowance” for cranial prostheses (wigs) if prescribed by a physician.  We would be happy to assist you in determining what benefits might be available to you under your plan.

In order to bill your insurance company for your products, we will need a prescription from your physician, certain personal and health information from you, and copies of your photo identification and health insurance card(s).

If you do not already have a doctor’s prescription for your products, or if your physician is not certain what information is required for us to file your claim, we would be happy to assist you in obtaining the necessary paperwork.

Euphoria is fully accredited by the American Board for Certification in Orthotics, Prosthetics & Pedorthics, Inc. (ABC).  This accreditation sets the standard for acceptance as a participating Medicare and Medicaid supplier of external breast prosthetics and related supplies.  Euphoria is  also a participating insurance provider in many private carrier networks, including Aetna, Anthem, Blue Cross-Blue Shield, Cofinity, Humana and Sagamore, to name just a few.  If you have questions regarding your particular provider network, please give us a call.