Insurance Coverage

General Insurance Information:

If we are billing your prescribed items, please bring the following to your scheduled consultation:

  • Current Prescription for billable items : can be faxed to (920) 393-4913
  • Current insurance card (s)
  • Complete a recent Face-to-Face with your prescribing Physician


HIPAA Notice of Privacy Practices (PDF)


Please arrive at least 15 minutes early to complete the registration process. 

Nell’s has been approved as an In-Network provider with:

Arise Health Network
Dean Health – Wigs/Cranial Prosthesis Only
Forward Health
Humana and Choice Care Network
Medicare *(Medicare Information)
Network Health
Network Health Medicare
Trilogy handles the following Insurance companies:

  • Assurant Health
  • CB-SISCO
  • CoreSource
  • Cypress
  • Health Payment Systems
  • Pekin
  • Prairie States
  • UMR
  • US Health & Life

WPS

Billable items MAY include:

  • Mastectomy Bras
  • Post Surgery Garments with Mastectomy Forms
  • Silicone or Equal Breast Prosthesis
  • Foam Breast Prosthesis
  • Prosthetic Nipple
  • Compression stocking 30-40 (medical compression)
  • Cranial Prosthetic (Wig)

Please Contact your insurance to find out your deductible and coverage’s for these items.

*Medicare Allowable items include:

  • One Silicone Breast Form – Every 2 years (2 forms for bilateral surgery)

OR

  • One Foam Breast Form – Every 6 months (2 forms for bilateral surgery)

AND

  • Mastectomy Bras are reimbursed as deemed Reasonable and Necessary

*Medicare is Primary:
In order to qualify for partial Medicare reimbursement, a licensed physician or other licensed healthcare professional, qualified, and eligible to order breast prostheses must prescribe the items you are ordering.   You also must complete a Face-to-Face meeting with your prescribing physician within 6 months of purchasing the items.

Nell’s will file your claim if Medicare is your Primary Medicare insurance and Medicare will partially reimburse you; however Nell’s may not be able to file claimed for Medicare Advantage Plans if we are not in network with the company. (i.e. HMO, AARP, etc)  Check your benefits and local providers

Supplemental/Secondary Insurance: 

If you have supplemental or secondary insurance, you may be entitled to additional reimbursement.