For the purpose of major medical, and supplemental insurance, items such as wigs, mastectomy bras, prosthetic breast inserts, etc. all qualify as prosthetic devices. Usually, the way this benefit works is you purchase the product and pay out of pocket. Try to pick a shop that is a provider for your insurance company. If you call your insurance company, they can help you find one if your area. If there isn't one, you can still get out of network benefits, which may pay less, but are still better than nothing. Get your doctor to write a prescription for the wig or prosthetic device. Submit a copy of the receipt, a copy of the prescription, and a completed claim form to the insurance company. They will pay a benefit according to the specifics of your plan's benefits. It was a simple process. My insurance paid for one prosthetic device per year, so the first year it was one of my wigs, and the second year it was my mastectomy bra with prosthetic inserts. I had not met my deductible yet the second year, so there was no reimbursement, but the amount was applied toward my deductible.
Keep in mind if you choose to get additional prosthetic devices such as extra wigs or mastectomy bras, these may not be covered by your insurance, so you will be responsible for the total cost of these items. I found that one mastectomy bra and one camisole were all that I really needed. I could wear one while washing the other. I also had two wigs, just so I could change up my look. After your hair starts growing back in, you can donate the wig(s) to the American Cancer Society (who will provide them to another cancer patient free of charge).
If you have supplemental insurance, like the cancer policy I mentioned in my last post, there is also usually a prosthetic benefit. You file a claim for it in the same manner as with you a major medical policy. The benefits for prosthetic devices on supplemental policies can vary greatly depending on the level of coverage you have chosen to carry. This is a benefit most people don’t know they have, so it is important to call and ask. My policy paid a $200 benefit for each prosthetic device. Between my major medical policy and my supplemental policy, I paid only about 50% of the total cost of my two wigs combined.
If you plan to get prosthetic devices, call all of your medical insurance companies, find out who the local providers are (if necessary), find out what your benefits are, and what the process is to file a claim. Every company is going to be a little different. You’ll also need to get a fax number or mailing address to submit the claim to. Ask how long it takes to process the claim and when you can expect to receive your reimbursement. These prosthetic devices are usually not cheap, so you’ll want to get reimbursed as much as you can. The paperwork only takes a few minutes to fill out and send in, so it is well worth a little legwork when you consider that your insurance company will likely pay anywhere from 70%-90% of the cost of the item, depending on your individual policy. Mine paid 80%. On a $300 wig, this was a $240 benefit. That was quite a nice reimbursement check! Between this benefit and the benefit from my supplemental policy, I only ended up paying about $150 for my two wigs combined.