If you are covered by MEDICARE, you are allowed :
MEDICARE IS PRIMARY :
In order to qualify for partial Medicare reimbursement, a licensed physician or other
- One SILICONE BREAST FORM every 2 years ( 2 forms for bilateral surgery )
- OR -
- One FOAM BREAST FORM every six months ( 2 forms for bilateral surgery)
- OR -
- One PERMAFORM BRA every six months ( 2 for bilateral surgery)
- AND -
- MASTECTOMY BRAS are reimbursed as deemed Reasonable and Necessary
licensed healthcare professional, qualified, and eligible to order breast prostheses
must prescribe the items you are ordering. Jodee will provide you with all necessary
documentation to assist you in obtaining partial Medicare reimbursement upon your
Jodee will file your claim if Medicare is your primary medicare insurance and Medicare
will partially reimburse you; however Jodee is not able to file claims for
Medicare Advantage Plans(i.e. HMO ,Managed care,Sterling,etc.).
SUPPLEMENTAL INSURANCE : If you have supplemented insurance, you may be entitled to additional
PRIVATE INSURANCE : If you are covered by private insurance ..
Most major medical insurance policies cover mastectomy products according to their guidelines.
We encourage you to call your insurance company to verify your benefits. Give them the procedure codes
listed below and they will be able to give you information regarding what your policy allows, how much they
pay, how many bras and breast forms you are eligible for each year and if you can receive pre-authorization
to purchase from Jodee.
|Silicone Breast Form
|Foam Breast Form
*NOTE : A "Reimbursement Fee Schedule for Bras and Prosthetics" is published by Medicare for the purpose of determining the amount allowable for these items. This amount varies from state to state, and can be lower than our catalog prices.
Jodee will file your claim for you and Medicare will reimburse you for up to 80% of the Medicare fee schedule.