Medicare is my primary insurer… it is often assumed that if Medicare won’t pay, neither will your secondary insurer. This is what I was told, so I paid for my compression sleeve and gauntlet. Several weeks later, I received benefit information from my group health plan, which included facts about the “Women’s Health & Cancer Rights Act”: http://www.dol.gov/ebsa/newsroom/fswhcra.html
In light of this information, I subsequently filed for payment on my own and received reimbursement in accordance with the provisions of my Major Medical Benefits. (Though the Act specifically mentions lymphedema in regards to mastectomy, I received coverage for lymphedema due to my lumpectomy, since that procedure and a lymphedema diagnosis were on file with my insurer.) Women need to be made aware of this provision and not just accept ‘no’, from the provider of their lymphedema supplies, when they inquire about insurance coverage … ask the supplier to file a claim anyway! If it’s denied, you can go from there, but you might be pleasantly surprised, as I was.
I hope the above information helps relieve the financial burden of life-saving lymphedema supplies.
*A note from the Lymphedema Advocacy Group: some private plans do voluntarily comply with the Women’s Health and Cancer Act, but not all, and although a secondary insurer usually will not cover something Medicare won’t, there are rare exceptions. As Millie said, everyone should always appeal each and every denial.
