Insurance for Sleeves and Gloves

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Annie2012
Annie2012 Member Posts: 32
edited June 2015 in Lymphedema

I am struggling with my Blue Cross Blue Shield  insurance with my sleeves and gloves. The medical providers and the insurance company do not agree on the pic codes, so therefore I am so limited on what I can get. The medical providers use the pic code number of L8010 for my sleeve and my insurance says this is a custom sleeve with that pic code, not one off the shelf. I only get the ones off the shelf. I have made many phone calls and am getting nowhere. BCBS won't change their pic codes and the home medical place won't change theirs. Therefore I am not covered, even though my policy says I can have 6 sleeves off the shelf a year. Grrr....Is anyone else struggling like this getting their home medical sleeves and gloves to go through insurance?


 

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited June 2015

    Can you pay for the sleeves/gloves and be reimbursed directly by your insurance company.  That would eliminate the problem with the pic codes.  My first set of bi-lat sleeves/gauntlets were paid for by me, the medical device company told me that my particular insurance would not pay for them.  In an unrelated conversation with my referral manager I was given an L code, about a year later.  I asked the medical device company to use that code for the next set and my insurance paid in full.  Frustrating, right?

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  • Annie2012
    Annie2012 Member Posts: 32
    edited June 2015

    Thank you SpecialK! I never thought of paying for them and then getting reimbursed. Are there no pic codes used then? It is something I will certainly check into though. Yes, so frustrated. I have never had an issue with BCBS before, all through chemo, surgery and rads. Not sure why they are being so difficult now. It is certainly not a fashion statement I ever wanted to wear that's for sure! :)


     

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited June 2015

    I think because you are interrupting the direct line between supplier and insurance company it allows the insurance company to reimburse you using whichever hcpc code they want to. This is essentially what I did with my wig prior to chemo. I paid for it but got a prescription from my oncologist for a "cranial prosthesis" and the receipt from the wig shop. I filled out the claim form and submitted the form, prescription and receipt to my insurance. They reimbursed me directly with a check. I am hoping this will work with your sleeves too

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