Insurance and Lymphedema Treatment
Lymphedema treatment requires ongoing care from a team of providers. You also will need to purchase supplies to control your swelling. This article provides you with information to use when speaking to your insurance company. Every insurance carrier and plan is different – you should find out the specifics of your plan before beginning treatment. Lymphedema is a chronic disease. If left untreated or under-treated, it can lead to infection, disability, disfigurement, or death.
Your Treatment Team
Physicians and Nurse Practitioners
Care of your lymphedema begins with a provider visit. A physiatrist (physical medicine and rehabilitation doctor), primary care physician, or oncologist will diagnose your lymphedema. It's helpful to see a provider who understands lymphedema and can be part of your care long-term.
Physical and Occupational Therapists
A physical or occupational therapist (PT/OT) who specializes in lymphedema should provide your lymphedema treatment. Treatment may start with complete decongestive therapy. Check with your insurance company about your benefits for PT/OT services. Most insurance plans cover PT/OT as a specialist visit. A specialist co-pay will be due for every PT/OT visit. You also want to be sure that the therapist is in-network with your insurance. Medicare covers PT/OT visits for medically necessary services. Remember that if you only have Medicare A and B, you will be responsible for 20% of the cost of your treatment. If you have a Medicare supplement, that 20% should be covered.
Lymphedema Treatment Supplies
Treatment for lymphedema includes the use of compression garments/bandages. There are three types of compression. (Learn more about garments and compression). Medicare covers compression garments (standard or custom-fitted) under Part B with 20% copay. Coverage of garments and bandages with other insurance depends on your coverage.
- Bandages: Initial and ongoing treatment involves the use of short-stretch bandages. Your therapist will give you specific information on how many bandages, which sizes, and where to order them.
- Compression garments: These garments are worn during the day to control swelling. Your therapist will help you determine when you are ready for compression garments and what size you will need. You may be able to purchase an "off-the-shelf" garment in a pre-set size, or you may need custom garments made. You should purchase two garments, so that one can be washed. Garments should be replaced every six months.
- Night-time bandage alternatives: You may need to wear compression at night. You cannot wear your daytime compression garments at night, because they can cut off blood flow like a tourniquet.
Talking to Your Insurance Company
Your insurance company may see bandages and compression garments as a type of "durable medical equipment" or "DME". For each garment/bandage listed above, get a letter of medical necessity from your healthcare provider. Use this letter to ask your insurance company to pay for your compression. If payment is denied, ask your healthcare provider for help filing an appeal to cover your supplies.
What if Insurance Will Not Pay?
If your insurance company will not pay for your compression bandages or garments, here is a list of some possible sources to obtain funds for the supplies your therapist has explained that you will need
CancerCare
1-800-813-HOPE
Living Beyond Breast Cancer
610-645-4567
The National Lymphedema Network (NLN)
Marilyn Westbrook Garment Fund
- The patient must be a member of the National Lymphedema Network.
- Individual membership costs $50.00
- Patient must be receiving treatment at an NLN affiliated clinic or with an NLN affiliated therapist.
- https://lymphnet.org/garment-program
The American Cancer Society (ACS)
Provides referrals to local resources for financial support.
800-ACS-2345
Many churches and synagogues have funds for members in need. Your family might be thrilled to know that there is something you truly need that they could help you with as a gift for a special occasion/ holiday. You can also consider fundraising options through crowdfunding.