While we cannot directly process insurance claims online due to insurance guidelines, you may have the opportunity to seek reimbursement for your Ruby Ribbon purchases. To assist you in this process, we've outlined a basic step-by-step guideline.

However, it's important to recognize that insurance plans and benefits vary widely. Our steps do not guarantee payment, nor do they ensure full reimbursement, as individual outcomes may differ. We strongly recommend reaching out to your insurance provider for comprehensive details on their requirements and procedures, as our guide serves as a general overview of how to proceed. Your insurance provider will provide the most accurate and specific guidance regarding your unique situation.

Insurance Coverage for Mastectomy Products:

• In the U.S., Medicare establishes general guidelines for coverage and benefits application.

• Currently, Medicare partially reimburses for:

  • Four to six mastectomy bras with pockets close to the chest, annually, or as medically needed and indicated by your doctor.

  • Additional bras due to surgery or weight changes.

  • Up to three camisoles per month, when medically necessary.

• These Medicare guidelines generally align with private insurers, but specifics may differ.

What May Vary with Private Insurers:

• The number of allowed pocketed bras or camisoles.

• The reimbursement amount for each product.

• Currently, on our site, only pocketed bras and tank top camisoles with petal pockets are eligible for reimbursement.

• Breast forms are not required, but the garment must have pockets.

Coverage Amount:

• Coverage varies based on your insurer and plan.

• Each company and plan determines a reasonable and customary fee schedule for billed products.

• This amount can significantly differ between insurance companies and even plans under the same carrier.

• For example, Medicare reimburses $31.39 per bra in Colorado, but only $26.68 per bra in Florida.

• To find out your potential reimbursement, contact your health insurance carrier and inquire about the fee schedule or reimbursement for billing code L8000 (mastectomy bra with pockets).

Factors Affecting Reimbursement:

The total reimbursement amount you receive may be influenced by several factors:

• What your insurance plan considers a reasonable and customary fee.

• Your copayment or coinsurance responsibility.

• Whether the product is subject to your deductible.

• Whether your deductible has been met.

• The fact that we are considered an out-of-network company.

How to Obtain Reimbursement:

We strongly emphasize the importance of discussing this process with your benefits coordinator or health insurance plan to ensure you have all necessary requirements and understand their reimbursement rates. To initiate reimbursement, you will likely need to provide the following:

1. A prescription from your physician specifying the need for a mastectomy or pocketed bra or camisole and the quantity needed.

2. A diagnosis code from your physician, typically included in your prescription.

3. An itemized receipt, which you'll receive via email after making your purchase.

4. The reimbursement form mandated by your insurance provider.

Your physician's office should be familiar with the reimbursement procedure and can provide you with the necessary prescription details. Additionally, some insurance providers may require pre-authorization for products, a step that can typically be initiated through your physician's office. It's advisable to discuss these specifics with your insurance provider to ensure a smooth reimbursement process.