Does Medicare Cover Lymphedema Treatment?

Medicare is a federal health insurance program. It gives coverage to most of the people who are above the age of 65 and some younger people too. When Americans are working, they pay into Medicare through their years of employment. Medicare covers mostly the acute conditions, the conditions that are quick to resolve. Some additional coverage is available, but that is at an extra cost, and the patient has to follow some strict guidelines for the same.

Medicare is a government program and any changes to it can be made only through legislation.

Does Medicare Cover Lymphedema Treatment?

For years now, lymphedema patients are trying to secure their rights to the coverage in Medicare. There have been small improvements though, and there seems to be some more hope in the future; however, at present, there is not much satisfactory provision for them in Medicare program.

When it comes to lymphedema treatment, it is a lifelong process. The affected persons have to undergo management therapies for throughout their lives, which can be a burden financially. The management of lymphedema involves several therapies and also includes a team of multi-disciplinary specialists, all of which can be exceptionally high on budget for most of the persons affected. Breast cancer management also requires such extensive care, and after years of struggle, long-term breast cancer care is now finally approved for American residents. However, the lymphedema people still face disappointment in this regard.

The main area of problem in lymphedema insurance approval is the compression garments and supplies. These do not fit properly into any of the categories included in the coverage. Many other private insurance companies also do not include this in their coverage norms. As a result, the chances of infections are much higher, if the proper equipment and treatment is not provided to those affected. Some companies do not even agree for services of a specialist; they insist that the bandaging process can be done by any trained medical professional.

When it comes to the supply of some other things, like pumps for the pneumonic compression therapy, one has to first try the basic models of pumps for weeks and weeks and give evidences for its failure, before they can apply for the advanced versions and it gets approved. As a result, precious time is lost doing all this and the lymphedema progresses to later stages, making it all the more difficult to treat and reverse.

Another difficulty encountered by lymphedema patients is that lymphedema is classified as a functional disease, whereas in reality it is an illness.

To obtain any kind of coverage for lymphedema, the patient has to carry a huge data of proof, which becomes a mental burden. Also, undergoing all these procedures involves money and it can become a financial burden too. Many cases are denied just because of some laughable reasons like the code are incorrect or the signature does not exactly match etc.

With all these denials, the process itself becomes an emotional burden on the patient and the financial mountain keeps rising.

However, there are some hopeful changes brought in the Medicare coverage system. People are the most hopeful of the Lymphedema Treatment Act, whose most current bill has already been presented. According to this act, the affected persons should be given compression garments as the part of the coverage; also the pumps etc. should be included. This bill is specifically presented by keeping in view Medicare. But, people believe many private insurance companies will also change their policies once government policies are changed.

People hope that the lymphedema sufferers will be granted a life-long care and coverage, in terms of all the necessary methods of treatment. States have already opined that the need for provision in the Medicare system for people suffering from lymphedema is essential. In a few places, this has been recognized and approved, and people continue to hope in other regions.

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:November 8, 2018

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