fitter and doctor delaying sleeves

Sewingnut - thank you for the suggestion. I just called my breast surgeons office too. Of course I have to leave a message, hoping my call gets returned. I just saw her last week for a follow up. If I would have known this was needed (been wearing sleeves for 8.5 years now) I would have asked for this when seeing her. She is a wonderful surgeon but her office is clueless on things like this. Why it has to be this complicated is beyond me.

Kira yes correct code. The nurse filled out the code and used the doctors notes but they only indicated arm edema. But the fitter wants written documentation of the oncologist diagnosis and the word "lymphedema" in the last office visit notes. The oncologist didn't diagnos it the breast surgeon did nearly 10 years ago when she sent me to the PT. I stopped at her office today to get the visit notes from a visit last week which did indicate I had "lymphedema" and wore a sleeve. Not sure if this would be enough because there is no code in the office visit. I am also not sure why the fitter needs to know all of my medical history and my recent office visit. Seems like an invasion of privacy to me. I could have been discussing private matters that have to do with the after affects of breast cancer and nothing to do with lymphedema.  I do have a call into the PA at the breast surgeon but her office is not good with this sort of thing so that's why I go to my oncologist. I have an appointment with my primary care doctor Monday for something else so I am not sure he would even want to get involved. My next step would be the PT but they don't believe in sleeves, they expect patients to wrap iindefinately and w/o foam or padding. Which I truely believe did more harm then good for me. The second PT is out patient at the hospital. I guess I could call them but by the time I get an appointment my measurements would be off. I wish it was just about a form looking for a signature but that is not good enough. I have made two trips to the fitter now, the new fitter is an hour one way. I just don't where else to turn.

Kira this is a new fitter. The claim has not even been sent because they wanted the additional information from the doctor and what he sent does not seem to be enough for them. I talked to the insurance company twice now and both times they said they do not need the additional information. The RX from the doctor with the diagnosis code is enough. The fitter says this is their company policy. The previous two fitters developed this policy a few years ago as well however they excepted what the doctor sent and there was no hold up.



The fitter did now say they would have the day sleeve made because the doctors notes would now work for those. But they will not make the night sleeve with those notes unless I leave my credit card with them. They are worried about the doctors notes and the fact I already had a night sleeve made and returned/claim being voided. Telling me my insurance company will not pay for my night sleeve until December because it will be a year from that time and I am only allowed to have one night sleeve a year and all this mess started last December. Once again the insurance company said no this is wrong. Even if the night sleeve was not returned the insurance company does not limit the number of sleeves (day or night) that I can get each year. Of course in the beginning of the year we have deductible to meet and the first set of sleeves can do this with no problem. But after that it is just a copay.



I did get a call from the PA at the breast surgeon. She left a message telling me she thinks she can help. So I am hoping to talk to her today.
The insurance company has offered to do a conference call with the fitter to get this all cleared up. It may come to this. Although not sure if the fitter will because they are telling me that my insurance company is just telling me what I want to hear. However my insurance company has never not covered any sleeve. Never denied any claim associated with my diagnosis or any thing associated with it. So this is where I hang in limbo. I do know any paper work needed I will have faxed to me and then I will fax it to the fitter. Something tells me this is the best route for the future.