Healthspan (Kaiser) Insurance Ohio Coverage and Sleeves

JohnM

My wife and I have coverage from Healthspan Insurance in Ohio. We were formerly covered by Kaiser Permanente, but Kaiser left Ohio and Healthspan succeeded them last year.

The coverage is supplemental (Medicare Plus) for my wife. She has Medicare as primary.

Healthspan disclosed in materials for 2014: "With Medicare Plus, you'll enjoy all the benefits of Medicare, plus all the benefits of your FEHB (federal employee) program." Also, in their 90 page book on my benefits for 2014, you will find "We have added coverage of compression sleeves and gloves used in treatment of physical complications of mastectomy, including lymphedema, under Durable medical equipment." Also, "We cover rental or purchase .. of durable medical equipment. Covered items include: ... Compression sleeves and gloves used in treatment of physical complications of mastectomy, including lymphedema."

When we ask Healthspan to pay for the sleeve and glove, they say "No. Since Medicare is primary, and they don't cover it, we won't either."

Nowhere is there any published disclosure of this limitation. Indeed, the language "plus all the benefits" leads me to the conclusion the cost of the sleeve and glove would be covered. 

I think I'm going crazy.

Binney4

Geesh, John! Definitely a mind game! I'm so sorry.

Since these are not exactly cheap items, this is well worth going after. One of our lymphedema heroes is Bob Weiss, also known as LymphActivist, who has been helping us all tackle insurance problems for years, all for the love of his wife, who is a fellow "Swell Sister". You can contact him at LymphActivist (at) aol (dot) com. His help is without cost, and he'll walk you through all the steps needed.

You're not going crazy, honest. There's hope--hang in there! Greet your wife for us. And please let us know how it goes.

Be well,
Binney