Need Letter for insurance coverage

hugz4u

I am trying to get some custom garments and my insurance company needs a formal letter of medical need for my garments before they will consider covering for me.

All my docs silly little prescription notes(he doesn't know much about LE so he can't write the proper letter) for custom garments are not being taken serious by my insurance company and I have been denied for some garments.

Is there a good letter that you can reccomend on the web or post something that is sure fire to work?

anna4969

Hi hugz4u

I have had my oncologist write out the prescription for the exact custom garment we want to order. I enlisted the help of my therapist as to what was appropriate and then told him what she advised. This has worked thus far, having the exact wording on the prescription itself like "Solaris Tribute" garment. He wasn't even sure what that was but had no issues writing out the specifics I had already written down for him. Maybe this will work instead of a letter?

So sorry you have to go through extra aggrivation. As if this isn't enough!!

Binney4

Hugz, the NLN has a sample MD appeal letter you might be able to adapt. It's here:

http://www.lymphnet.org/lymphedemaFAQs/insuranceIssues.htm

The ignorance about LE is breathtaking, no? Aaaaugh! Let us know how this goes, please!

Hugs right back at ya'!

Binney

hugz4u

Thanks Binney I will use a few sentences and draft up a letter for my doc. This is that doc that laughed at me and said I would NEVER get LE. Hum I guess he is eating his words a few years later.

cinnamonsmiles

Does that letter work for Medicare as well? I thought I read somewhere on here that there was somebody that figured out a way to bill LE garments to Medicare so that they will pay for it. Can anyone refresh me? I put a hole in my new LE garments when it caught on my metal medical alert bracelet. The hole keeps getting bigger and I simply can't afford another right now. (I can't use one of the LE websites because the therapist needs to be certified and I don't have any in my area certifed by the NLN).

carol57

cinnamon, here's Bob Weiss's website:

http://www.lymphactivist.org/whoweare.php

He's the wonderful person who has been patiently and diligently helping people go through insurance and Medicare appeals to ultimately get garments covered. He has a great batting average, but I am pretty sure that you have to pay for garments and then go through a lengthy appeal process, which he generously will help you with as an unpaid coach. Bob's goal is to have tons of appeals be settled in favor of garment coverage, so that eventually 'case law' within Medicare recognizes that the garments should be covered. His successful strategy to date has been to demonstrate that a compression garment functions as a prosthetic device, compensating for a malfunctioning lymphatic system.

Anyway, take a look at his website, which I believe has a contact form on it. The man is a total saint, incredibly generous with his time, and you can count on him for accurate information about insurance and Medicare issues.

Binney4

Cinnamon, I'll second Carol's advice and wanted to add that FrayChek, which you can buy at any fabric store or department, can be used on compression garments to stop holes from getting bigger. It's actually used in serger sewing to end sewing rows so they don't ravel, but it works well for this purpose too, stopping the fabric from running without being too stiff.

Do keep us posted! Hugs,

Binney