External Breast Prostheses Reimbursement Program

 

 

Provides reimbursement of up to $400 for new or replacement external breast prostheses for women who have had a mastectomy as a result of breast cancer. You can claim a reimbursement for new or replacement external breast prostheses purchased after 1 July 2008. No timeframes apply on when the mastectomy was performed. The program does not cover other purchases such as bras, mastectomy swimwear or internal prostheses. To claim your reimbursement, you must be a permanent resident of Australia

• be eligible for Medicare

• have had a mastectomy as a result of breast cancer

Exceptions If you currently receive financial assistance from the Department of Veterans’ Affairs (DVA) you should claim your entitlement through DVA.

No need to worry as we will help you complete all paperwork for either Medicare or DVA and submit for you..

 

DVA Gold card holders are entitled to a breast prosthesis every 2 years with no out of pocket expense plus 4 free bras every year. We will assist you in lodging your claim with DVA. The great advantage is we bill DVA direct!

In 2009 a review was undertaken of the program and its effectiveness. Please see a summary below - 

 

Key findings

The Program demonstrated a number of achievements in its first year. In total 17,997 claims had been processed and 19,962 reimbursements paid by 31 December 2009; the total cost of the reimbursement program to the Commonwealth amounted to $6,130,011.52. 

The reimbursement scheme was considered to be nationally consistent, easily accessible; efficient in process; and sensitive to the needs of women accessing the Program. Respondents considered that the Program had contributed to the quality of life for women who had undergone a mastectomy as a result of breast cancer and required a breast prosthesis. The Business Rules and Service Arrangement between the Department and Medicare Australia provided an acceptable and appropriate structure for the Program.

Impact of the Program Consultations with representatives of stakeholder organisations and women who had accessed the Program indicated primarily positive perceptions of the Program. Over three quarters of women responding to the survey (77%) agreed or strongly agreed that the Program had improved their quality of life.  More than three quarters (81%) of women surveyed agreed or strongly agreed that they were treated with sensitivity whilst making their claim. Over three quarters (76%) said that they had been pleased with their overall experience of the Program. 

Breast care nurses and breast prostheses suppliers were the leading sources of information about the Program. Forty-two percent of women surveyed reported hearing about the Program from their breast care nurses, and over one third (34%) reported hearing about the Program through a breast prostheses supplier.
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The large majority of women consulted (83%) reported that the Program had made it easier to afford a breast prosthesis. The Program was praised for its simplified claims process. More than three quarters of women surveyed (79%) said that they had found the process of being reimbursed was straightforward. Overall, respondents reported that the Program was a significant improvement on previous state and territory-based schemes. Several areas of improvement or concern were identified. A number of respondents commented that the Program required wider promotion. 

Only half (50%) of women surveyed agreed that a reimbursement every two years is sufficient. The inability to afford the upfront payment for an external prosthesis, particularly for women experiencing financial hardship, was a concern of many respondents, although the extent of this is not quantified.

The following proposals are made for the future. 
- The Program is promoted in a more targeted way to clinicians and consumers, through the media, at BreastScreen units, and through targeted advertising. 
- Consideration is given as the Program progresses to research which will quantify the number of women who may be prevented from accessing the Program because they are not able to afford the initial purchase of a prosthesis. 
- Consideration is given to providing discretion for reimbursements within the two-year time frame within a carefully described set of circumstances, particular weight loss due to cancer treatment. 
- Information and promotional resources are developed in languages other than English, and promoted to a wide range of culturally diverse community groups. 

For the full report go to https://www.ogtr.gov.au/internet/main/publishing.nsf/Content/6750470BFF42B2F5CA257BF0001DAB37/$File/evprosth.pdf

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