Need help locating a NJ/NY/PA garment provider that takes BC/BS

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KS1
KS1 Member Posts: 632
edited February 2015 in Lymphedema

The DME company I used to get my garments from (SunMedical) is no longer an in-network provider for my insurance company (Horizon BC/BS of NJ).  I called 65 NJ DME companies that are in-network, and none do custom Juzo garments.  

I have measurements,so all I need is a company that accepts BC/BS and is a Juzo dealer for custom garments.

Does anyone know of a lymphedema garment provider in NJ that accepts BC/BS? 

Bizarrely, my policy treats any non-NJ company/provider who accepts BC/BS as being in-network, so I would also love leads on non-NJ BC/BS companies. 

Thanks, KS1

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  • carol57
    carol57 Member Posts: 3,567
    edited March 2014

    KS1, lots of therapists around the country work with Luna Medical in Chicago, and they definitely work directly with patients. I am nearly 100% certain that they accept BC/BS in all states.  I go to them for my needs--it's about 3 hours from home, and I went for measures to get my Tribute--and they are terrific.  A CLT at the last NLN conference told me about them.  Link:  www.lunamedical.com .  All they do is lymphedema and venous insufficiency products.

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  • KS1
    KS1 Member Posts: 632
    edited March 2014

    Thanks for the lead, Carol!  Fingers crossed, it looks like Luna Medical will work insurance-wise.   Now, all I have to find is a fitter who is in network ...   KS1

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  • KS1
    KS1 Member Posts: 632
    edited January 2015

    Hi All,

    I can't believe it's been almost a year and since I posted and I am still trying to get my insurance company (Horizon BC/BS of NJ) to cover my garments. The good news: I found a fabulous LTx who did measurements not too far from my work. She is out-of-network but worked with me on prices. (PM me if you want her name). The bad news: despite Luna Medical's assurances that they would accept my insurance, I ended up only getting meager out of network benefits for one set of sleeves last year.

    My day sleeve and glove are shot, and it's making my LE is getting harder to control. My New Year's resolution was to get new garments, but calls to almost 100 DME companies failed to find a NJ Horizon BC/BS in-network provider that will order custom garments.

    An odd loophole in my BC/BS policy allows me to go to non-NJ BC/BS companies and get in-network DME coverage but ONLY if the garment is delivered to an address within the catchment area of the non-NJ BC/BS. I have relatives in NY, NH, CT and MA who I could have garments shipped to. Does anyone know of an in-network BC/BS providers in NY (Empire or Excellus), NH (Anthem), or MA who does custom lymphedema garments (Juzo glove & sleeve and/or Tribute)?

    KS1

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  • sandcastle
    sandcastle Member Posts: 587
    edited January 2015

    KS1.....I live at the Jersey Shore and use Lymphedema Products in Jersey........I pay for them myself.........and do not go through insurance.....they do not take insurance...and for what it is worth....a big hassle....I have Anthem....Liz

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  • Izzyfran
    Izzyfran Member Posts: 78
    edited January 2015

    KS1,

    Try Falk Surgical Suppliesin 1st Avenue (ny). They take insurance, not sure about Empire.

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  • sandcastle
    sandcastle Member Posts: 587
    edited January 2015

    Izzyfran....What was you experience with Falk?  I did google them.....the reviews are not good from Customers.......My daughter lives in NYC...and I thought I might mosey over there....but after reading all the complaints and there were many.....I will rely on Lymphedema Products...they are helpful over the phone......Liz

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  • cookiegal
    cookiegal Member Posts: 3,296
    edited February 2015

    sandcastle...ok I highly recommend falk as long as you deal with Jeanette. The garments I got other places were a joke...they have more choices and get the job done. They will get you into custom if you need it and sell Barton Carey which is my favorite glove.

    I will say the complaints are not wrong...they can be disorganized...and slow. But in my opinion it is worth it

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  • cookiegal
    cookiegal Member Posts: 3,296
    edited January 2015

    I will add that they serve an Upper East Side clientele that is used to being catered to and is demanding. There is always somebody grumbling in there. But again they changed my life with better garments and better fittings. I do fear what will happen when Jeanette retires

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  • KS1
    KS1 Member Posts: 632
    edited January 2015

    Hi all,

    Thanks so much for pointing me to Falk Surgical Supply

    According to Falk's billing guru, they accept Empire BC/BS and they know how to bill non-Empire BC/BS. For non-Empire BC/BS policies, the garment has to be picked up at the store or shipped to a NY address in order for the garments to be covered at within network rates. This all fit with what I had learned over the years, so I decided to order garments through them.

    Falk has two fitters, Maria (who works M-W) and Jeannette (who works W-F). I used Maria, who said she has been fitting garments for 40 years. I will let you know how things turn out. KS1

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  • sandcastle
    sandcastle Member Posts: 587
    edited January 2015

    Thanks Girls......Glad I did get your Feedback......you have been helpful......Liz

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  • Izzyfran
    Izzyfran Member Posts: 78
    edited February 2015

    KS1, I'm glad it worked out for you.

    Sandcastle, I read bad reviews before going to Falk as well, but had no choice since they were the only ones I could go that would take insurance. I dealt with Jeanette and she was good at her job. I was only there once, but my experience was good. They didn't have one of the gauntlet and they shipped it to me for free. I'm heading back there again since now I have to use a glove instead of a gauntlet.

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