We became a Medicare Accredited Facility several years ago, the standards for accreditation are very strict and very costly to the shop owners, Medicare requires that we be bonded, insured, and certified as mastectomy fitters: we are certified mastectomy fitters with American Board for Certification or ABC. Additionally Medicare conducts site visits and audits our records/files to insure we are compliant with their standards: we are proud to say we have passed again this year and remain an Accredited Medicare Facility complying with over 26 standards set by Medicare.

Things have changed in 2010 and now 2011 is bringing even more concerns about our health care. Let me assure you that coverage for mastectomy products remains protected under the Women’s Health and Cancer Rights Act of 1998 and it will not be amended, these rights remain protected. That being said each insurance company can and does change the number of item’s you can receive. Medicare now covers 12 bras per year. Why so many? Your bra is a medical device that supports and holds a prosthetic and is able to withstand repeated use and used primarily for a medical purpose. They want you to have the perfect fit every time you put on a bra not a stretched out bra that does not hold your breast form tight against your chest wall. Some insurance companies will cover whatever is medically necessary others may only allow for one bra per year, please check with your insurance carrier every year to see if your coverage has changed, don’t assume things have remained the same. No matter what your insurance covers you need more then one bra per year, you deserve to take good care of yourself: a bra that does not fit right and hold the prosthetic close against your chest wall may cause shoulder pain and may cause neck discomfort. 

 Medicare sets all of the standards for medical coverage, they determine how much will be paid on every item submitted to Medicare and private insurance. Therefore fitters are all created equal in getting you the best coverage possible with your insurance company; we all have to take the same write down to match the allowed amount of coverage set by Medicare. This year Medicare reduced their coverage: providers are now being paid less for the same products we billed for in the past. I just wish our vendors would have reduced there costs as well. With the high price of fuel and wages we are seeing a 30% increase in cost of goods from all manufactures.

Neither Medicare nor private insurance companies allows us to raise our prices to cover the high cost of goods, we continue to find the best products at the best price so as not to compromise your standard of quality. There maybe upgrades for items that are not consider a standard product: A standard product is any item that does not have any special features, such as a camisole bra; smooth cups or molded cups and underwire are not considered standard nor are attachable forms or “specialty” forms. Some may wonder why these products are so costly. The bras have to be engineered to carry a prosthetic and not do any bodily harm, a breast form is designed to distribute the weight like a natural breast and perform for over two years, and not break down from body chemistry. They are semi-handmade, perfectly balanced, and take many hours/days to make. They must be stored in a perfectly controlled temperate carefully packaged and shipped. The form is made of silicone that has been carefully developed to feel like a natural breast. Every form is inspected and must meet Medicare’s guidelines for prosthetic devices. This industry is always researching and developing new products to make your lives better and more comfortable. What price can we put on that?

When a product is covered under your insurance guidelines it only means that they recognized the products as medically necessary: your co-pay and deductible will always apply and may cause a small out of pocket expenditure from you- owed to A Fitting Place. We are “governed” to accept Medicare guidelines for all billable items. Co-pays are different with each policy & most insurance companies have these. Medicare is an 80/20 policy this means you are responsible for 20% of the bill AFTER the insurance company takes all of the discounts. We may bill a bra at $48.00 dollars if you do not have a secondary policy you may owe less then $8.00 for that $8.00 bra: If you have a secondary policy they usually pay the 20% Medicare does not pay, leaving you with no out- of- pocket expense at all. Deductible: Each policy is different; please find out how your deductible is calculated or if you have met your deductible so you are prepared to pay your portion of the bill.

RX and Doctors Notes

All insurance companies mandate that we have a new doctor’s prescription on file every year along with any medical history your insurance company may require and a photo ID. Whenever insurance is being billed to pay for something they need to know why (?) your RX proves a doctor has seen you and you do need the prescribed product. This medical history is especially important for any wig coverage due to Alopecia Areata.

Massage is often recommended by surgeons to better assist the body‘s circulation and lymph drainage. Not everyone wants nor should have deep tissue massage but rather a feather like touch. Call Chrissy to discuss the best technique for your comfort and care or consult with your doctor and see what treatment he/she might recommend. Be good to yourself and indulge in something just for you! Perfect gift to give to get!