Cancer Truth Note: #60
If you have breast cancer related lymphedema (BCRL) your compression garments must be covered by insurance under the law!
In 1998 the Women’s Health and Cancer Act was passed. In this law compression garments for management of cancer related lymphedema are covered expenses. Yet it is common for this coverage to be rejected.
We got some great news on December 23, 2022, The Lymphedema Treatment Act was finally passed by Congress after 11 years of advocacy on the hill. This is really good news because that means compression garments for all patients managing lymphedema will be included under Medicare coverage and subsequently under insurance as a covered cost. During 2023 Medicare will be determining exactly what that looks like.
Since this coverage has not been available due to a hole in the Medicare statute, women cancer survivors with cancer related lymphedema often have their compression garment orders rejected by insurers as not covered. However, it was a supervisor at United Healthcare who told me, “We cannot reject this. It is required by law.” She became my go to call for years every time my order was canceled or rejected by their one supplier.
These garments are expensive. Using insurance can mean the difference between $13 to $26 sleeves or $131 sleeves and that is for a simple off the shelf garment for mild lymphedema. More advanced lymphedema garments can cost $1000 per sleeve. These need to be worn daily and should be replaced every 3 to 6 months depending on the severity of your condition.
Cancer is expensive enough. Do not pay more than you need to for items covered by law. The good news is help is coming, it will likely not go into effect for a couple more years. Unfortunately, this is one of those areas where we need to advocate, advocate, advocate! Do you have BCRL? Do you know your risks? Have you experienced issues ordering garments? Let me know in the comments.
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