Using superglue Insurance coverage 2008 survivor

Syrongnow

Hi,

I went flat until 2 years ago and started using Aomena prostheses. They are falling apart and the superglue is no longer is keeping them together. I called Blue Cross and was told they only pay 85 percent. Does this sound right? Should I buy them (very expensive) or try to get full coverage??

Thank you.

Moderators

Hi Syrongnow and welcome to Breastcancer.org!

We just wanted to stop by to say hi and let you know someone should be by shortly to answer your questions! You may also want to post in the Employment, Insurance, and Other Financial Issues forum to better help you reach others who can help.

We hope this helps and look forward to hearing more from you soon!

--The Mods

Momof6littles

Have you thought about Knitted Knockers http://www.knittedknockers.org/

Or Awesome Breastforms http://awesomebreastforms.org/

They are handmade by volunteers and free. I am told they are very comfortable and lightweight. Awesome Breastforms has swimming ones as well.

BarredOwl

Hi Syrongnow:

I am not sure exactly what you are asking.

By the way, some insurance plans only provide coverage for new prostheses every two years. So, if you did not discuss this with Blue Cross, you may want to check into a possible time limits, and be sure the date of purchase is timed for when fresh coverage is available.

Here is a thread about peoples' experiences with insurance coverage for prostheses:

https://community.breastcancer.org/forum/113/topics/833708?page=1#post_4451773

My Blue Cross coverage at the time was a very good "PPO" plan, which may differ from yours in some way, or they may have changed their policies since then. I could not get a clear answer about my coverage when I called Blue Cross, but when I went to the hospital boutique, they told me my insurer typically covered three bras and a pair of forms, which I got and was not billed. The boutique was considered part of the hospital (in network), and the insurance covered 100% of the three bras and pair of silicone forms. (That was June 2014, Blue Cross Blue Shield PPO of either MA or IL).

A silicone form can be ~$250 (or more) for a single one, so a pair can exceed $500. If you have any insurance coverage available (even partial), I am not sure why you would not try to use it. Insurance reimbursement requires a prescription. If you do not have an unexpired prescription for bilateral breast prostheses, call your surgeon's office to request one.

Another member here had a similar issue with Amoena forms falling apart, and called the company. Their answer led me to believe this may be a form of planned obsolescence, because of available insurance coverage. So, I would look for forms from a different manufacturer, such as American Breast Care (ABC).

Reputable boutiques and hospital-based boutiques can process the insurance reimbursement forms for you, if you give them a copy of your prescription. Call ahead to ask if the boutique will handle insurance reimbursement requests and what their recent experience has been with coverage from Blue Cross (of the kind you have). Also ask if they have prostheses from a manufacturer other than Amoena and schedule a fitting. If you switch manufacturers, you will want to try on the forms for size and profile, as these can differ between manufacturers and styles. Wear a close fitting tee to evaluate the look.

Good luck!

BarredOwl

crystalphm

Yes, Blue Cross pays for %80 in my case, so it was alot of money for me to come up with. It makes me angry because the general public thinks we get these things for free because they are covered by health insurance, but it never works. I paid $100 out of pocket.

How old are the forms?