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Insurance Coverage - Are You Eligible?

 

Provincial Insurance plans provide coverage on breast prosthesis but what many don’t know is that most Private or Group Health Insurance policies cover mastectomy bras in Canada.   With over 2/3 of Canadians having some form of private health insurance, most women are eligible for coverage and will receive reimbursement for pocketed bras purchased after surgery and for years afterward.  In addition, many women are able to claim other treatment and cancer related products including bathing suits, hats, wigs and breast forms.

To help navigate the insurance process, here are some answers to frequently asked questions:

Will my insurance cover bras?

In our experience, most private insurance companies in Canada cover surgical bras and post-mastectomy bras.  Typically, insurance companies will limit their coverage to only those bras that are classified as “surgical” or “mastectomy” and/or “pocketed”.  Reconstruction bras may not be covered.

How many bras will be covered?

This depends on your policy.  Most private insurance plans will cover between 2-6 bras per year or the equivalent value.  This will vary by provider and medical need. It is always best to ask your insurance company on the specific details of your policy. 

How many years will my bras be covered?

We have found that most insurance providers do not put a limit on the number of years they provide coverage so long as the bras are still needed and meet the classifications/requirements set out in your policy.  For example, if you underwent a mastectomy over 10 years prior and still require the use of breast prosthesis, most plans will continue to reimburse you for the amount and/or value stipulated in your policy provided you have an official receipt indicating that they are mastectomy and/or pocketed bras. 

What other products may be covered?

Again, depending on the insurance provider, this can vary widely.  Some of the more typical products covered outside of bras are pocketed swimsuits, hats and wigs.  We have had customers with insurance plans that top-up silicone prosthesis purchases and cover the costs of wigs and mastectomy garments.  Other insurance companies allow their plan members to claim up to a specified number of medically related products, no matter the cost, on an annual basis.  Other women have told us that their insurance provider, with a prescription from a medical doctor, will cover the cost of hats and wigs due to hair loss and moisture-wicking pyjamas due to medically induced menopause.   Due to the variance from plan to plan, we strongly encourage you to contact your provider and be prepared to ask about coverage for these other items and/or any item you require due to your cancer diagnosis, surgery and treatment. 

Can I get a quote before purchase to submit to ensure I have coverage?

Yes!  We would be happy to provide you with a quotation that you can submit to your insurance company for assessment prior to making a purchase.  Please contact us for a quotation.

What should I do next?

Please contact your insurance provider!  If you have private insurance coverage, it is absolutely worth your time to make the call.  From our experience, most private insurance plans assist cancer patients BUT they vary wildly in what they cover, the manner in which they cover it and the items deemed eligible for coverage.    

ALL insurance companies require receipts and in most cases, they are somewhat particular about the format of which they are submitted.  We will prepare a personalized receipt or quotation according to the specifications set out by your provider. To avoid frustration and an overly lengthy process, be sure to check with your insurance provider to determine what they require by way of prescriptions and receipt details.   

We are here to help!  If you have any questions, please contact us at info@gorgeousyou.ca or give us a call 905-717-0030.

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