Still Me, Inc. will verify each patient’s insurance coverage before any products are considered for home management of his/her lymphedema. Any financial obligations will be clearly explained to the patient.
As experts in both private insurance and Medicare coverage, we work directly with insurance carriers. We are “in-network” with Anthem, Blue Cross Blue Shield, Cigna, Humana, Multiplan, Medicaid, Medicare, Tricare and we also work with the VA.
We are also “in-network” with many other insurance companies and insurance networks as well.
• Secondary Insurance: If a patient has a secondary plan to Medicare, we can assist them in getting possible reimbursement for their medical products. All payments will be subject to any deductibles and/or coinsurances due in accordance to the plan provisions. Plans such as Tricare, BCBS Federal, etc. usually have these types of benefits. These secondary plans are usually offered to patients from former employers. The secondary insurance will consider picking up as the primary payer with proof of a denial from Medicare. We will file a claim electronically to Medicare for a denial and subsequently to the secondary insurance with proof of the Medicare denial.
• Supplemental Insurance: If Medicare denies a claim, the supplemental insurance will also deny the claim.
Medicare Advantage Policies: These plans are administered by a health plan and act as an HMO. Since these plans will follow Medicare guidelines, they will not pay for lymphedema medical products.
Private Pay: We offer discounts to patients paying “out-of-pocket” for lymphedema medical products.
Compression Pump Coverage
Compression pumps are generally covered by all Insurances if the patient qualifies.
Compression Garment Coverage
Every Insurance is different for compression garment coverage so each request for coverage will need to be checked.
Medicare does not cover compression garments with the exception of compression or Velcro Wraps for open Venous Stasis Ulcer.
QUALIFYING WOUND
An open venous stasis ulcer treated by a doctor at the time of dispensing the Velcro Wraps.
Location onbody: Below the knee – primarily found on the inner part of the leg, just above the ankle. Ulcers may affect one or both legs.
DOCUMENTATION
A signed RX with venous stasis ulcer diagnoses. The doctor’s documentation must show the diagnoses of a active venous stasis ulcer in the time period that the patient receives the product. The therapist documents without the doctor’s documentation does not qualify.
Diagnoses Codes
I87.311 – Chronic venous hypertension (idiopathic) with ulcer of right lower extremity
I87.312 – Chronic venous hypertension (idiopathic) with ulcer of left lower extremity
I87.313 – Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity
I87.319 – Chronic venous hypertension (idiopathic) with ulcer of unspecified lower extremity
Insurance Authorizations
When authorization is required we will need to submit an authorization requests to an insurance company. We handle everything for this and depending on the insurance it can take anywhere from 5-30 business days for them to approve the authorizations. Which in the meantime means we cannot place any requested order until the approved authorization is received by Still Me.
Compression Pumps usually require authorization for coverage.
Compression Garment sometimes require authorization.