Will Insurance Cover My Compression Garments?

THE REAL QUESTION IS…

Will my insurance company cover my compression garments for lymphedema? Will Medicare cover my compression garments? Sometimes yes, but more often, they will not. If they do pay, the real question is, how much will they pay? It’s all part of the medical insurance game. The other day I needed to purchase a prescription drug. I was shocked when they told me the price was over $600. When I explained to them I did not have insurance to cover this drug, they said, “Oh, then we can give you a discount; it will now be only $60.” How can that be? How can a drug price drop that drastically?

THE GAME

I have worked in different capacities in the medical field on and off for the past 45 years. I have seen the insurance industry’s evolution and interaction with the medical profession. Unfortunately, it has continually declined, possibly to the point of no return. It has all become big business, and the patient is on the short end.

The games the medical profession and the insurance companies play leave those needing medical care stranded in the middle. This is one reason I have elected to opt out of the insurance game. So often, professionals bill the value of a compression garment three times (if not more) to get their “fair share” after the insurance companies take their cuts. The problem is the customer often pays more through their deductibles and co-pays than if they would have paid cash upfront.

It’s a vicious cycle. First, the medical professionals inflate their costs, so the insurance companies take more off their reimbursements, and then the medical professionals have to raise their rates. Then, the insurance companies pay less and less, if at all. It’s a game of deception and greed.

AN ALTERNATIVE

By creating The Compression Closet, I can provide lymphedema therapists and their patients with an alternative to the insurance game. One of the reasons I started my own business was to run it how I saw fit, with integrity and honesty. There are no shell games and no hidden costs here. I no longer have to play the game I did when working with the insurance companies, nor do you.

WORKING WITH YOU

Compression is not cheap; no one knows this better than I do. However, I am continually working with my therapists and their patients to provide them with the best compression for the best value possible.

I also have simplified the process of purchasing compression garments. We only offer garments proven to be the most effective for the lymphedema condition.

If you wish to seek reimbursements, all receipts have the necessary HCPC coding to submit to your insurance company. Then, when you offer that bill, you will know that you have paid an honest price for a quality product. No games, no lies, no inflated pricing, or double billing.

COMPRESSION GARMENTS FOR LYMPHEDEMA

Compression garments are an essential aspect of the management of lymphedema. However, many insurance companies won’t cover garments for this condition. It is necessary to check with your insurance company to learn more about your coverage. You will need your diagnosis and the HCPC code of your compression garments. You’ll want to know the percentage the insurance company will pay and what percentage will be your responsibility. You may find that purchasing your garments up front will be less expensive, and then submitting the paperwork for possible reimbursement.

One example would be the cost of the Tribute Wrap MCP-Axilla. The MSRP for this garment is currently $551.40. This is the price you would most likely pay if you purchased this garment at a durable medical supply store. However, at The Compression Closet, the price currently is $294.08.

Whether the insurance company will reimburse you or not, know that at The Compression Closet, we will do our very best to continue to give the highest quality compression garments for the best value! Working with therapists and their patients to help empower you to achieve a better quality of life.

LYMPHEDEMA TREATMENT ACT

Since I wrote this blog post a few years back, legislation has changed, and Medicare may soon cover compression garments for lymphedema. However, we do not know the reimbursement or how many garments they will cover each year. I understand that by January 2024, new guidelines will be in place for Medicare to cover compression garments for lymphedema.

Disclaimer – This blog is for general information purposes only. Furthermore, the information in this blog is not a substitute for medical advice – always consult a licensed healthcare professional for advice on your specific condition.