Insurance 101: Products Covered by Insurance

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 which products are likely covered by your insurance policy and which products are not covered.

Typically, insurance will cover durable medical equipment (DME) products based on their medical necessity. Each insurance company and policy will cover these products at a different rate and frequency, but here are some general guidelines.

Almost Always Covered by Insurance:

Silicone breast prostheses: Following both a single or double mastectomy, without reconstructive surgery, insurance will cover silicone prostheses. Prostheses are considered medically necessary to maintain balance and symmetry. This can help prevent back problems, in addition to helping many women feel more comfortable following a mastectomy. Because of their high quality and durability, new silicone breast prostheses are usually covered every two years.

Partial breast prostheses (surgical side): Thinner silicone prostheses that can help provide balance and symmetry, especially after reconstructive surgery. Insurance will likely cover partial breast prostheses on sides that have had surgery. Partial breast prostheses may also be covered for other conditions not related to breast cancer.

Bras: Pocketed bras to hold silicone prosthesis. The bras we carry are the best quality and will be supportive while holding prostheses close to your chest wall. In order to maintain their structure and support, they should be replaced regularly. Insurance will usually cover 4+ bras per year (sometime 4 bras per quarter!). We highly suggest replacing your bras as frequently as your insurance allows.

Post-surgical camisoles: After a mastectomy, these camisoles are helpful and comfortable during recovery. Because they aid in drain management, insurance companies consider them medically necessary. Usually, insurance will cover two camisoles for use following your surgery. 

Lymphedema compression sleeves: These are prescribed by a doctor or lymphedema specialist to treat, manage, or prevent swelling. Your doctor may prescribe a sleeve and a gauntlet/glove for your hand. Insurance will usually cover several at a time and replace them each year.

Sometimes Covered by Insurance:

Active breast prostheses: Unlike silicone prostheses, these can be worn for working out or swimming because they are filled with microbeads and are easily cleaned. Some, but not all, insurances will cover active prostheses in addition to normal silicone prostheses. New active prostheses are often covered every six months.

Custom silicone breast prostheses: Feminine Forms is the expert in custom breast prostheses in Utah and we offer two great different types of custom forms. These are incredibly lightweight, scanned to fit directly against your chest wall, and completely customizable with colors, freckles, and even tattoos. Some insurance companies will cover custom silicone prostheses, but they can be expensive; we suggest keeping up with your deductible/out-of-pocket levels so you can get them during a year when you have already met those costs.

Wigs: During chemotherapy, wigs can be considered “cranial prostheses” so they may be covered by some insurance policies. Figuring out a policy’s wig credit can be a more complicated process than many of the other products, so we highly suggest that you call your insurance company to confirm your policy’s wig credit.

Not Covered by Insurance:

Swimsuits: We have so many cute styles of swimsuits with pockets for active prostheses. Unfortunately, insurance does not consider cute swimsuits to be medically necessary.

Hats and headcovers: Many of our hats are made out of the softest bamboo material – perfect for everyday wear and sleep, while our sun hats are SPF protected and very cute. However, insurance will not cover hats or headcovers.

Partial breast prostheses (non-surgical side): Thinner silicone prostheses that can help provide balance and symmetry, especially after reconstructive surgery. Insurance will not cover partial breast prosthesis on a non-surgical side.

Each insurance company and policy will have different guidelines for covering DME products related to breast cancer, but we are happy to work with you to find out specifics on your insurance policy.