LE coverage

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cinnamonsmiles
cinnamonsmiles Member Posts: 779
edited June 2014 in Lymphedema
I was snooping around the 1998 Women's Health and Cancer Rights Act. The American Cancer Society states that one part of it says Under the WHCRA, mastectomy benefits must cover:

Reconstruction of the breast that was removed by mastectomy
Surgery and reconstruction of the other breast to make the breasts look symmetrical or balanced after mastectomy
Any external breast prostheses (breast forms that fit into your bra) that are needed before or during the reconstruction
Any physical complications at all stages of mastectomy, including lymphedema

If LE Sleeves are part of the treatment for LE, what loophole is Medicare and other insurance companies using to deny sleeve/gauntlet coverage? 

Interesting: According to the American Cancer Web Info on this law.."Do the WHCRA requirements apply to Medicare or Medicaid?

No. The law does not apply to Medicare and Medicaid."

http://www.cancer.org/Treatment/FindingandPayingforTreatment/ManagingInsuranceIssues/womens-health-and-cancer-rights-act

I am on medicare and think I wll be calling them next week to find out. 

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  • crystalphm
    crystalphm Member Posts: 1,138
    edited August 2012

    Please post and share your information. My mother had a lymph node removed not related to breast cancer, and her leg went up huge. She is now getting treatment, but wow, are these whole leg things expensive! And no coverage on both medicare, Pace and a supplement Blue cross plan.

    I also have LE in my arm, BC related, and the strange thing is one time insurance paid, I had a prescirption and blue cross paid. But now they say they never pay. (sleeve and gauntlet to fly)

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  • lago
    lago Member Posts: 17,186
    edited August 2012

    My mom has to wear compression stockings for the lymphedema in her legs. She's had it since as long as I can remember. Medicare will not pay. She buys them online and watches for specials.

    Also if you can wear lymphediva sleeves that do sell seconds at 1/2 price. The second is in the decorative pattern not in the actual weave: http://www.lymphedivas.com/store/pc/viewcontent.asp?idpage=2

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  • carol57
    carol57 Member Posts: 3,567
    edited August 2012
    You might try http://www.brightlifedirect.com and look at their Allegro sleeve, gauntlet, and sleeve/gauntlet combo. They are inexpensive compared to the other makers. I tried them when I wanted to build a good supply of compression to use while camping/kayaking, when I knew I would not be able to launder properly and would probably get wet and want to change them out a lot.  I use the sleeve/gauntlet combo; I think it's about $45.  Sleeve alone is $27 and gauntlet is $15. Comes only in 20-30mmhg compression. I tried the sleeve, but it is way too long on me, although the sleeve/gauntlet combo fits fine.  If it doesn't fit, you can return within 30 days, and although you have to pay return shipping, these things are cheap to ship.  They also have leg compression in this line.
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  • lago
    lago Member Posts: 17,186
    edited August 2012

    My mom orders from britelifedirect too. Also recommended by my LANA trained LE specialist.

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  • crystalphm
    crystalphm Member Posts: 1,138
    edited August 2012

    Thank you all for the wonderful information!! I really appreciate this, my local fitter charges $60 for the sleeve and same for the gauntlet, considering I need the 4 pieces to fly, it is daunting.

    And I did not know about the lymphadiva's seconds, wonderful information! Thank you.

    This sort of thing really makes it all a bit easier and I thank you!

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