Does insurance generally cover LE garments?

aunt_paula

Hi everyone--

I've just had an LE evaluation and am going to be doing LE therapy. I decided to look online at gloves/sleeves/vests and am wondering if that will be an out-of-pocket expense, or if insurance generally covers it? 

Thanks!

Paula

SpecialK

Some insurance covers it, others don't.  Generally if they are willing to pay for PT they will cover the sleeves if you are diagnosed with LE.  Prophy sleeves for prevention, possibly not covered.  If you get fitted by a medical supply company many of them have insurance coordinators that will be able to advise you ahead of time.

aunt_paula

Thanks--hopefully it will cover at least part then. It does cover PT/OT, so maybe it will cover one sleeve and the vest and glove. The prophylactic sleeve I'm glad to cover, but I was having some sticker shock. LOL

carol57

Aunt Paula, the vests have been difficult to get covered, unfortunately. It seems that most insurance companies consider garments that treat truncal LE experimental, although sleeves, gauntlets and gloves are commonly covered.  Except by Medicare, which covers no garments at all.  Is the vest you're considering prophylactic? If so, that's a new approach to me.   Lots of us use shapewear or UnderArmour compression shirts to help with truncal LE, as these are much more affordable than compression vests or bras.  None of this is simple, is it?

aunt_paula

The vest isn't prophylactic; it's to treat the swelling in my neck and chest. The right arm sleeve is the only prophylactic garment, and the therapist recommended it because the side where I have the LE is the side that had no nodes taken, so theoretically I "shouldn't" have it there. She believes that I'm at high risk of developing it on the side where I did have nodes taken so wants me to wear a sleeve on that side as a preventative measure. 

It isn't easy! As she was explaining things to me, it slowly dawned that this is going to be a much bigger deal than I'd expected. I've read some, but really thought it would be a mild inconvenience briefly, not a life-altering big deal. After hearing her, and asking questions, I'm beginning to realize there's a lot more to it than I'd realized--not a complaint, but definitely a realization that I was glossing over a lot. I think too the fact that my arm hurts pretty consistently now is bringing that home--before, I had the achiness off and on, but now it's more persistent, especially in my wrist and hand (which weren't giving me much trouble before). I have a lot to learn!

I am definitely going to ask about using shapewear to address it--that is a great idea!

carol57

aunt paula, check with your insurance because even with a lymphedema diagnosis most consider the vest experimental and don't cover it. If you find that's true and want to fight a denial, you can ask for great advise from Bob Weiss, an LE advocate who has helped several LE patients argue successfully for vest coverage on appeal. His email address is lymphactivist[at] aol dot com and he encourages us to check in for help because he is trying to build a body of cases to bolster his ongoing advocacy work.