The Luna Blog

DO YOU KNOW WHERE TO REFER YOUR LYMPHEDEMA PATIENTS FOR COMPLETE “IN-NETWORK” COVERAGE WITH INSURANCE COMPANIES?

Don’t let your patients’ suffer from minimum or no insurance coverage because they’re being referred to providers that are NOT CONTRACTED with their insurance.

THE WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998

Under this Act, insurance companies must provide coverage for breast cancer survivors that include physical complications such as lymphedema.

http://www.dol.gov/ebsa/publications/whcra.html

Luna Medical, Inc. is a durable medical equipment company and authorized provider of lymphedema medical products nationwide, established in 1996 to meet the needs of patients suffering from chronic, extremity circulation disorders.  We are solely dedicated to providing compression therapy products.

We have national contracts with the following insurance companies:

• Cigna Healthcare • Humana • Tricare • United Healthcare • BlueCross BlueShield Federal
We also have contracts or able to bill the following insurance companies:

• Medical Mutual • HealthChoice • Homelink • MVP • UMR • NALC

We can obtain in-network coverage for:

•AETNA (FLORIDA ONLY)

We can obtain coverage for plans that access the MultiPlan Network

Luna Medical, Inc. is also contracted with Blue Cross Blue Shield of Illinois and has been able to provide in-network in various other states of BCBS due to an in-network deficiency because there are no providers for custom compression garments in that state.

Depending on the insurance plan (no authorization needed), prescription, patient’s consent and attached measurements—orders can be placed within 24 hours of initial request.

Patients and therapists have stressed many concerns including:  lymphedema products that do not fit properly, misinformed about insurance, provider is “out-of-network” with the insurance, charged up front for products when they have insurance coverage, provided standard size products when custom-made products are necessary and returns/alterations are not being handled in a fashionable manner.  The bottom line here is:  Lymphedema therapists need to refer patients to contracted providers for their product needs!

Ancillary providers can bill all insurance companies. If a provider states they can COMPLIMENTARY BILL and they are not contracted with the insurance company, the claim will be paid “OUT-OF-NETWORK” and the cost goes to the patient!

An ancillary provider (dealer) can be a Durable Medical Equipment Company (DME), Orthotic & Prosthetic company (O&P) or Pharmacy.  An ancillary provider is licensed and insured to provide medical products to patients for use in their homes.  Larger insurance companies contract directly with ancillary providers.  Smaller insurance companies contract with insurance networks that are contracted directly with ancillary providers.

Unfortunately, Medicare is still not paying for lymphedema products.  If a patient has a secondary insurance plan, these patients may have coverage for lymphedema products (we will always check this prior to ordering).  The dealer MUST be a Medicare provider whereby they can bill Medicare for a denial and process that denial to the Secondary Insurance for payment, subject to deductibles and coinsurances.

Thanks to the WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998, Insurance companies must provide coverage for lymphedema products to patients that have a history of breast cancer.  Unfortunately, this does NOT apply to Medicare or Medicare Replacement HMOs.

Every therapist should have a list of providers that includes what insurance companies the dealers are contracted with as “in-network” providers.  This should include dealers that provide custom-made, elastic support.  Patients should not be subject to Ready to Wear (off the shelf) products when custom products are warranted for proper containment.

THERE SHOULD BE NO HIDDEN SECRETS REGARDING WHAT INSURANCE CONTRACTS A DEALER HAS…So here’s the question you can ask your provider of choice inquiring if they are contracted:

I am requesting a list of the major insurance companies you are contracted with as an

“in-network” provider.  I understand dealers can complimentary bill any insurance

company however this is not my question as I need my patients to have the most coverage

possible to reduce their cost.

Just a reminder, billing patients out of pocket and telling them to submit the bill to their insurance for reimbursement does not offer them insurance coverage.

Lymphedema Therapists should have a clear understanding of where to refer their patients for insurance coverage.  It’s not just about a provider filling an order as a one-time deal.   It’s about the long term product needs for a chronic condition.

Patients are entitled to daytime, elastic support every 6 months (one set for wash and one set for wear); custom or non-custom.  Patients are entitled to one nighttime garment per year.

It really is not fair if a patient has insurance benefits and they are directed to an “out-of-network” provider costing the patient thousands of dollars when there’s a provider like Luna Medical, Inc.—where we are all about PATIENT ADVOCACY!

If we at Luna Medical can be of any assistance, please call toll free at 1-800-380-4339 or email us at info@lunamedical.com.  You can also visit our website at www.lunamedical.com to access our referral form packet and manufacturers’ measuring forms for new patients.

Kindest Regards,
Curtis S. Bumgarner
CEO/President
cbumgarner@lunamedical.com

November 4, 2013
Disclaimer: This website is designed for educational purposes only and is not a substitute for professional care. The information provided here should not be used for diagnosing or treating a health problem or a disease. If you have, or suspect you may have a health problem, you should consult your physician. All medical products require a physician's prescription.