On this page you will find important information regarding your appointment and resources you may find helpful.

Prior to Your Visit

CONTACT SHEET – Please print, fill out and bring to your first appointment or email to requests@fittingsbymichele.com (You may also elect to fill this out at your visit)

Please review these forms prior to your appointment: PRIVACY POLICY, MEDICARE SUPPLIER STANDARDS

NOTIFICATION OF PATIENT POLICIES – You will need to sign this form before items can be dispensed.

Return Policy: All sales are final. Fittings By Michele does not allow returns or exchanges unless an item is defective and within manufacturer’s warranty time limits.

Payments: Fittings By Michele accepts cash, check, credit cards, Zelle and Venmo. Out-of-pocket expenses are collected at the time of service. This includes any deductible, co-insurance, co-pay and non-covered services. For non-assigned claims, the entire balance is collected at time of service. There is a 4% processing fee for credit and debit cards. We also offer CareCredit financing, subject to approval with minimum monthly payments. There is a $50 fee for returned checks.

Third Party Billing: Fittings By Michele offers insurance billing for Medicare and many other insurance companies for covered items when supporting medical record documentation is obtained prior to dispensing. Our office will often check your coverage and benefits prior to your visit and provide you with an estimate of your expected out-of-pocket costs. This is not a guarantee of insurance payment. Insurance company representatives do not give a guarantee of complete accuracy when coverage and benefits are obtained, and claims are all subject to documentation of medical need and plan limitations. You will be financially responsible for deductibles, copays, coinsurance and for items not covered or denied by your insurance plan. If you have a concern over coverage and benefits for a particular service, we recommend that you contact your insurance company to verify coverage and benefit information prior to your visit.

AETNA and AETNA ADVANTAGE – Our contract was updated on 7/15/2024 to include mastectomy products, wigs, billable compression garments. Compression garment coverage is based upon your individual plan limitations and exclusions.

CAREFIRST/BLUE CROSS/BLUE SHIELD – WE ARE OUT OF NETWORK WITH CAREFIRST WITH THE EXCEPTION OF MOST CAREFIRST ADVANTAGE PLANS. THE MEMBER IS RESPONSIBLE FOR VERIFYING OUT OF NETWORK COVERAGE AND BENEFITS AND WILL NEED TO FILE THEIR OWN CLAIM. We will give you a copy of your doctor order and a detailed receipt for claim submission.

We can bill most CIGNA plans and Johns Hopkins HealthCare plans for post mastectomy supplies and certain compression garments.

MEDICARE – Depending upon the items you purchase and your deductible status, some claims may be billed assigned and some claims will be billed non-assigned. For non-assigned claims, the member will pay upfront and we file your claim for Medicare to reimburse you based upon their fee schedule and coverage. For Medicare Advantage Plans, call or email us to find out if we are able to bill for you.

UNITED HEALTHCARE – Our contract was updated on 3/1/2025 to include mastectomy products, wigs, billable compression garments. Compression garment coverage is based upon your individual plan limitations and exclusions.

Insurance Coverage/Billing for Medically Necessary Compression Garments – On 1/1/2024, CMS added 81 new procedure codes for lymphedema products. The reimbursement that Medicare set for many of these codes was not what providers had hoped it would be. Many of our commercial insurance and Medicare Advantage contracts do not include these codes and some plans either will not allow us to file a claim with these codes or will only reimburse based on a percentage of the Medicare fees. We have worked dilligently with major commercial plans to attempt to have these codes added to our contract to be paid at a fair rate. Contact us on your individual plan restrictions. We also recommend you contact your plans member services to verify coverage before your appointment as well.

LYMPHEDEMA COMPRESSION GARMENTS

*2026 UPDATE: Insurances are now implementing pre-payment and post-payment audits to document the medical need and validity of payments on claims for compression garments. Prior to you appointment, we must have a vaild prescription from your referring provider to include your diagnosis code(s), clear product descriptions that correspond to the new procedure codes, including the body part, type of garment(s), compression level if applicable, and whether a ready to wear garment or custom garment is needed. In addition, we must obtain a copy of clinical notes from your permanent medical record at your referring provider from a face-to-face office visit within the last 6 months. The progress note must provide the rationale for the prescribed items and clearly document the medical necessity for each garment, including a description of the lymphedema by body part, noting stage and severity, followed by the compression garment type(s) needed to treat that body part and any necessary options. The diagnosis code must be present in the prescribing clinician’s notes, not just on the prescription. This may require a visit to your doctor or lymphedema therapist prior to your visit with us. Use the following link below for a print out for your referring provider to make sure they document the necessary notes needed for your garments to be billed:

PROVIDER HANDOUT FOR COMPRESSION GARMENT COVERAGE REQUIREMENTS – Print this handout for your doctor to make sure all necessary documentation is put into your permanent medical record to support medical necessity for compression garments if you would like to have us file an insurance claim for you (See Page 2 of this document for examples of clear clinical notes).

Without a vaild order and a recent progress note that substantiate medical need in detail, we will be unable to bill your insurance claim and you may be charged a non-refundable fee for an office visit for a compression garment consultation if you decide not to purchase at your visit.

TELEHEALTH CONSENT FORM – Prior to a TELEHEALTH APPOINTMENT, you will need to fill out this form and email to requests@fittingsbymichele.com

COVID PROTOCOL – UPDATED NOV 2022 – Masks are optional at all of our locations, including the cancer centers. If you prefer we wear a mask for your fitting, please notify us beforehand.

Many of the items we carry are billable to your insurance and require a detailed written order with supporting documentation from your referring practitioner. You may request we fax this request to your referring provider or you may forward to your referring provider to have them complete and fax or email to us before your appointment.

Dispensing Orders:	These forms are provided for your information:
Breast Products Custom Breast Prosthesis Wigs (Cranial Prosthesis) Upper Extremity Compression Garments Lower Extremity Compression Garments	Medicare Supplier Standards Privacy Policy

Before Your Wig Appointment Before Your Compression Garment Appointment

Return Policy: No returns or exchanges allowed unless item is defective and within manufacturers warranty time limits.

Payments: We accept cash, check and credit cards. We collect any out of pocket expenses (deductible, coinsurance, co-pay and non-assigned claims) at time of service. We do charge a 4% processing fee for credit and debit cards. We also offer CareCredit financing, subject to approval with minimum monthly payments.

Apply here to prequalify for CareCredit financing

After Your Visit

Instructions for Wig Care: