Medicare/Insurance

Medicare claims must be submitted by the company from which the purchase was made. After we have received your payment, we will submit your Medicare form and you will be reimbursed directly by Medicare. Medicare provides partial reimbursement for breast forms, mastectomy bras and camis, regardless of when you had surgery.

Currently the allowable is:

  • 1 Silicone Breast Form (2 Forms for bilateral surgeries) every 2 years or one Foam Form (2 Forms for bilateral surgeries) every 6 months.
  • 4-6 Mastectomy Bras annually, or as many as are medically needed/indicated by your doctor. Additional Bras may be prescribed as a result of surgery and/or loss or gain of weight
  • As many Camis as are medically necessary, but not more than 3 per month.

If you carry supplemental medical insurance, please be sure to contact your insurance provider for reimbursement. If you are not eligible for Medicare, be sure to file a claim with your health insurance provider.

A Medicare information sheet will be sent with your order. If you are eligible for Medicare, fill it out and return it to us with your doctor's prescription, dated on or before the date of your order. Inquiries about reimbursement should be made through your Medicare office. Please allow 10-12 weeks for reimbursement.
TLC cannot guarantee Medicare reimbursement, which is based on Medicare's assessment of a patient's needs. Please note that many private insurance companies will reimburse for hairpieces if your doctor writes a prescription specifying a "necessary cranial prosthesis."

Please note: We can file for Medicare reimbursement on your behalf only if your primary provider is Medicare. We cannot file if your primary is Medicare HMO, Managed Care, Sterling, or MVP (USA Care).

View the Medicare Regulations here.