For Providers

 

Thank you for choosing HERS Breast Cancer Foundation Program Stores for your patient’s post-surgical needs. We require a prescription or an authorization before we can schedule an appointment. Please take the necessary steps below to assist us in providing the best care for your patient.

If you have any questions, please feel free to contact us:
Phone: 510-790-1911 | Fax: 510-505-9160

Thank You,
HERS Breast Cancer Foundation

 

For patients with PPO and Medicare insurance plans:

Please complete and have MD sign the prescription provided below:

• General Rx Request Form
• Rx Request Form for Custom Lymphedema Garments

For patients with HMO insurance plans:

• HERS Authorization and Prescription Process

MD must fax a prior-authorization request to the patient’s insurance plan. Request must include:

• Completed prior authorization request form (see Resources, below)
• Patient clinicals/history and physical
• Signed prescription or referral from MD with the correct CPT codes and quantity.

Fax us the approved authorization once completed.

Resources:

HMO insurance plans prior-authorization request forms:

• Alameda Alliance
• Valley Health Plan
• Santa Clara Family Health Plan
• Contra Costa Family Health Plan

Submit prior-authorization requests through provider portal for the following insurance plans:

• Kaiser (new requests). Call DME line for refills: 1-877-317-6230
• United Health Care
• Blue Cross
• Blue Shield