Medicare claims must be submitted by the company from which the
purchase was made. Many of our customers are eligible for Medicare, and
we are happy to file claims for them. The process is quite simple.
We do not accept Medicare assignment, so we do request that you pay
for your prosthesis when you order, and Medicare will reimburse you
directly. When you place an order, check the box that says Medicare
Claim Request. In the package with the Bosom Buddy®, we will include
a brief form to complete which asks for your name and address, date of
birth and Medicare number, as well as your signature, authorizing us to
file a claim on your behalf. You will need to complete the form and
return it to us, with a prescription from your doctor. It need not be
the doctor who performed your surgery; any doctor who knows your medical
history can write the prescription. It is a Medicare requirement that we
have both your signature and your doctor’s prescription on file before
we submit your claim.
If you prefer, you can download and print the
Request form or fill it out on your computer, then print and sign
it. Either way, we must receive the signed form back from you along with
your doctor's prescription.
We will file your claim electronically to one of four Medicare
regions around the country that process claims for breast prostheses.
The claim will not be filed with your local Medicare office, and in most
cases, not even in the state where you live. You should hear from
Medicare within four to six weeks after the claim is filed.
Medicare generally reimburses 80% of the cost of a Bosom Buddy,
excluding the shipping and handling charge. Since the price of our
breast form is much lower than others, Medicare allows claims for a new
Bosom Buddy every six months, or two prostheses if you have had
bilateral surgery (both breasts removed.)
If your Medicare coverage is provided through an HMO (Health
Maintenance Organization), the benefits will be different, and our
prosthesis may not be covered. Some HMOs will allow our form if prior
approval is obtained. You should check with your own carrier to see what
you have any questions about your Medicare coverage, you are welcome to
send us an e-mail or call our toll-free number, 1-800-262-2789.
If we can’t answer your question, we’ll give you a toll-free number to
call Medicare and determine the specific coverage allowed.
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