Start with your primary insurance company. The number for customer service will be located on your insurance card. If your primary does not cover your item, call your secondary, tertiary, etc.

Find out if the item(s) you medically need (have a current prescription for) are a covered benefit under your insurance plan.

If the items are covered under your insurance plan, find out how many you are allowed per year and how many you are allowed at a time.  (Quantity/Frequency)

If we are an in-network provider for the item(s) you are purchasing, yes, we will bill your insurance directly.  You will still need to meet your deductible, pay for any co-insurance amounts, and above and beyond. These are due at time of service.

Bring along to your appointment, your insurance cards (Primary, Secondary, Tertiary, etc) and a current prescription for items needing to be billed.

Please arrive for your appointment 10 minutes early to fill out the proper insurance paperwork.

Generally, if we are an out-of-network provider, we encourage our guests to contact their insurance to see if they will allow this particular purchase to be covered at an in-network level.  Insurance companies call this a pre-authorization or a network gap exception.

A network gap exception is a tool health insurance companies use to compensate for gaps in their network of contracted health care providers. When your health insurer grants you a network gap exception, also known as a clinical gap exception, it’s allowing you to get health care from an out-of-network provider while paying the lower in-network cost-sharing fees.

You will still need to meet your deductible and pay for any co-insurance amounts, and may be requested to pay these at time of service.

We highly recommend you contact your insurance provider to confirm coverage for the items you are looking to be reimbursement for.  If your insurance says they will cover the items, please be proactive, get everything in writing or a reference number, including the insurance representatives name you spoke with.

You will also need to obtain a prescription for medical necessity, from your medical practitioner, for the billable items.  Bring this with you to your initial appointment.  You may also have your practitioner’s office fax it to us at (920) 393-4913.

Most insurance policy/plans cover what Medicare deems medically necessary. Medicare does not cover mastectomy swimsuits or swim prostheses. We encourage you to check with your individual insurance policy or Health Savings Account (HSA) to find out your benefits.