Insurance 101: Key Terms

At Feminine Forms, we are proud to offer you the highest quality products for each stage of your breast cancer journey. In order to make the process of finding products that work best for you easy and smooth, we have contracted in-network with many insurance companies so that we can file claims directly with your insurance companies. Many insurance companies will cover products that are medically necessary throughout your surgery, treatments, and recovery – usually continuing to cover products, as needed, throughout your life. 

While we do everything we can to make sure the insurance process is smooth for you as our customers, it is important for you to understand your insurance policy, including what products it will cover and the portion you will be expected to pay. Each insurance company may differ slightly, and individual plans can also vary, so we cannot give definite answers concerning exactly how your policy will cover products from Feminine Forms until after we file a claim. Understanding the details of your health insurance policy is crucial to ensure that you can access the necessary healthcare services without facing excessive out-of-pocket costs. 

Our Insurance 101 blog series aims to help you understand the basics of how your insurance policy covers products from Feminine Forms, prepare you to use your insurance policy to cover your needs, and give you the information you need to advocate for yourself with your insurance company. This post will explain some basic key terms for understanding your insurance policy.

Policy: A contract between the insured (policyholder) and the insurer, outlining the terms and conditions of the insurance coverage. Review your health insurance policy document thoroughly. It outlines the terms, conditions, and specifics of your coverage. We try to know how most insurance companies typically cover our products, but each policy is different. 

Durable medical equipment (DME): Refers to reusable medical devices prescribed by healthcare professionals for long-term use in assisting individuals with medical conditions or disabilities. DME is designed for extended use and is often covered by insurance when prescribed.

Deductibles: The amount you must pay out of pocket before your insurance coverage begins. The portion you pay for your products will likely go towards your deductible (or, if you have met your deductible, it will go towards your out-of-pocket total for the year). 

Coinsurance rate: A percentage of costs you share with the insurance company after meeting the deductible. Anything you pay after you have met your deductible will be split with your insurance by the coinsurance rate, your portion will add to your out-of-pocket total for the year).

Out-of-pocket maximum: The highest amount an individual has to personally pay for covered healthcare services within a specific period, typically a year. Once this limit is reached, the insurance plan covers all remaining eligible healthcare costs, providing financial protection for the insured individual. If you have reached your out-of-pocket maximum for the year, all products should be covered by your insurance.

Renewal date: When your insurance policy renews, your deductible and out-of-pocket maximum also renew. Make sure you know that date so that you can get products before your deductible and out-of-pocket costs reset. 

Coverage limits: Check if your policy has limits on the total amount the insurance will pay over the policy's lifetime or within a specific year. For example, many insurance companies will cover six new bras in a one-year period and one new breast prosthesis in a two-year period (specific numbers change depending on the insurance company and policy).

In-Network vs. Out-of-Network: Health insurance plans often have networks of healthcare providers. In-network providers generally cost less than out-of-network providers. We try to have contracts to be in-network with as many of the major insurance companies as possible – then we can file directly with the insurance company and usually get a better (less expensive) outcome for you! If we are not contracted in network with your insurance company, we are still happy to work with you to get the best possible outcome for you.