lymphedema pump

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rndh
rndh Member Posts: 9
edited June 2014 in Lymphedema

in appeal with Horizon BC BS NJ to use Flexitouch pump.  I have truncal lymphedema, chest, back, outer upper arm, very painfull, aching, consuming, in PT presently with massage making me feel better, using sleeve/gauntlet/compression bra, swell spots, unable to do self because of very bad bilat thumb joint arthritis, had cortisone shots, wear thumb splints.  I feel hopeless & afraid that they will not approve this therapy.  Can anyone help?

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  • kira66715
    kira66715 Member Posts: 4,681
    edited January 2011

    Most of the women here have had to fight to get their flexitouch approved: most found that the company did a good job with the appeals process

    http://www.tactilesystems.com/flexitouch/healthcare.html

    Some women found their local reps to be "on the ball" and got the appeal done, others have had to contact tactile systems at the main office.

    I've read the Cigna insurance benefit, and although it shows that flexitouch is the better pump, it refuses to cover it (logic???)--so you have to get a "benefit over-ride"--I would imagine the BCBS has a similar benefit--where they'll deny it automatically--and need to go through appeals.

    I'd recommend:

    1) Contact Tactile systems from the link above

    2) Contact your flexitouch rep

    3) Get a letter of medical necessity from your doctor

    4) There's a man: Bob Weiss, who helps people fight these appeals, he's on these boards, and you can pm him:

    http://community.breastcancer.org/member/75363/profile

    Let us know how you make out. It's a fight, but worth it.

    Kira

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  • rndh
    rndh Member Posts: 9
    edited January 2011

    Tactile has me doing the appeal.  I have sent the letter from my doctor & the package prepared by Flexitouch.  Horizon said it is being reviewed by a outside group & that they have 15 days to send me the decision.  I will contact Bob Weiss. I just want to do all I can. Thanks for the advice.

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