I'd be interested in knowing which of the Resources cited would help a cancer survivor with chronic lymphedema access and pay for the compression bandages and garments required for daily management of their lymphedema. Medicare does not cover these medically required items even though they meet the coverage criteria for "prosthetic device benefits".
Congratulations in getting the medical treatment likely to be the appropriate medical treatment for your individual case. You are correct in your observation that the insurance clerks who make coverage decisions are not medically knowledgable to make these decisions. You are fortunate in having a knowledgeable physician who is persistent in supporting you. I have been helping lymphedema patients in receiving the compression bandages and garments for 15 years and will testify that if the lymphedema patient gives in without a fight (that means appealing denials) there is zero chance of being reimbursed for these necessary medical items, but if the patient is persistent, there is a 2/3 chance of reimbursement based on my experience. You may read
What you seem to be describing is a lymphocele, a collection of lymphatic fluid collecting in a pool, and able to be removed by draining with a syringe. This is not lymphedema, although it is a risk factor for eventual development of lymphedema.
Approximately a quarter of the survivors of cancer treatment (breast, melanoma, genitourinary, head and neck, etc.) will eventually have to cope with the lifelong condition of lymphedema. In spite of this, Medicare and many health insurers do not cover the costs of the compression bandage systems, garments, devices and supplies which must be used by the survivor every day to control their lymphedema. Uncontrolled lymphedema leaves the survivor at greatly increased risk of recurrent infection and progression to harder to treat stages and eventually to disability. In only one state of the union has the ACA brought an improvement to the plight of the lymphedema patient. California has defined the "essential health benefits" offered by marketplace insurance contracts to explicitly include "compression burn garments and
Please be careful about reading too much into this thread. My observations based on reading the posted notices, corresponding with Mr. Scrivens directly, and reading the available references to rebounders:
Mr. Scrivens is NOT a doctor. Mr. Scrivens uses the title "Lymphologist", but he is not a lymphologist as the title is used in Europe for medical doctors who have completed specialty training in the lymphatic system and its pathologies. The lymphology he refers to is not the medical specialty taught in medical schools. He admits in private correspondence that he is not a doctor.
Nowhere in the rebounder literature he posts on his commercial website is there a shred of data showing the effects (either beneficial or damaging) of rebounding on a patient who has lymphedema. ...
There is a wealth of information on lymphedema patients' rights, appeal procedures, and other lymphedema treatment issues on my LymphActivist's Site at www.lymphactivist.org. Descriptions of your condition and their impact on your life are useful in disability insurance cases, but are of limited or of no use in appealing denials of treatment.
One thing I have learned after 20 years of fighting Medicare and other insurers is that appeals can only be won within the rules written in the Evidence of Coverage and associated policies. This is the legal contract between you and the insurer. These policies must be requested and read from beginning to end, and arguments developed and supported with medical evidence in your physician's or therapist's notes and in your medical record. ...
Physical Therapist with lymphedema training must be a part of the breast cancer team. It is a fact that lymphedema of the upper extremity and/or lymphedema of the breast affects 10-40% of breast cancer survivors. Some breast cancer treatment decisions, made by the patient and her treatment team, will affect the health and quality of life of the patient for the rest of her life. These decisions often involve a trade off between risk of recurrence versus risk of lymphedema, and current information on both must be made available to the patient before an informed decision is made. Issues such as extent and type of surgery, necessity for adjuvent radiotherapy, desirability for hormonal therapy, type of reconstruction and desirability for lymph node transfer, risk of ...