External Breast Prostheses
External breast prostheses are used to replace the anatomical breast after removal through mastectomy. They are typically worn in conjunction with a specialized bra containing a pouch that maintains the proper anatomical position of the external breast prosthesis.
The Doctor’s Prescription for your Prosthesis
Medicare and most payers require a valid and complete prescription from a physician in order to provide coverage for a prosthesis. Your physician will typically provide you with a prescription for a prosthesis as well as a referral to a prosthetist in order to complete the fabrication and fit of your prosthesis. The physician should communicate his or her desires for the type, style, and design of the prosthesis that best suits your medical need. As the recipient of the prosthesis, your involvement in this process is crucial toward obtaining a positive outcome. Do not be afraid to ask questions regarding what type of prosthesis is right for you and how it may help improve your overall health.
Your Prosthesis and Your Health Insurance
Most insurance plans, whether private or public, provide coverage for prostheses. Traditional Medicare covers prostheses with a 20% coinsurance. For patients who have Medicare and a Medicare supplement policy, their prosthesis may be covered with little to no out-of-pocket cost.
The provider of your prosthesis should provide you with a complete estimate of the cost of your prosthesis, including any patient responsibility, prior to delivery of the prosthesis. If this cost estimate is not offered, ask for it. It is not an unreasonable request and providers who are not willing to provide a cost estimate should be used with caution.
The Good News: Prostheses have been Shown to Improve Quality of Life, Mobility, Rehabilitation, and an Overall Reduction in Total HealthCare Expenditures for Patients and Payers
A current area of focus on the delivery of healthcare in the United States is the use of cost-effective delivery models that reduce the overall cost of healthcare to both patients and insurers. Recent studies on the cost effectiveness of prostheses have shown promising results. Studies show that the use of a prosthesis actually reduces the overall cost of healthcare as a result of increased patient mobility and a reduction in related health issues. Additional studies are currently underway to further quantify actual cost savings in healthcare expenses for patients who receive a prosthesis as opposed to those who do not.
Victory Orthotics has several mastectomy specialists to assist you with your selection of mastectomy products. Our compassionate staff will assist you through the fitting procedure, and answer any questions that you may have regarding this process..