If you are covered by medicare, you are entitled to :
- 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)
- AND -
- As many MASTECTOMY BRAS as MEDICALLY NECESSARY
MEDICARE IS PRIMARY :
In order to qualify for partial Medicare reimbursement, a licensed physician or other
healthcare professional licensed, 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
order.
Jodee will file your claim if Medicare is your primary and Medicare will partially
reimburse you . If your primary is Medicare HMO, Managed Care, Sterling or
MVP(USA Care) we cannot file for you.
SUPPLEMENTAL INSURANCE : If you have supplemented insurance, you may be entitled to additional
reimbursement.
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.
| Silicone Breast Form |
L8030 |
| Foam Breast Form |
L8020 |
| Mastectomy Bras |
L8000 |
| Perma-Form/unilateral |
L8001 |
| Perma-Form/bilateral |
L8002 |
*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 schedule.