Insurance Coverage

Luna Medical, 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.

A “Notice of Privacy Practices” (HIPAA) form will be signed by the patient or guardian prior to verification of insurance benefits.

Many patients have insurance plans that will only pay a certain dollar amount per year for all medical products, known as a cap per year. It is relevant to work with a company such as Luna Medical that practices cost containment.

An “out-of-network” provider of lymphedema products is one which has not contracted with the insurance company for reimbursement at a negotiated rate. Some health plans, like HMOs, do not reimburse out-of-network providers at all, which means the patient will be responsible for the full amount charged by the provider. Other health plans offer coverage for “out-of-network” providers, but the patient responsibility would be much higher than it would be if you were seeing an “in-network” provider.

An “In-network” provider of lymphedema products is one which has contracted with the insurance company for reimbursement at a negotiated rate. This expedites the authorization process and provides members the insurance coverage that they are entitled to:

We are “in-network” with Blue Cross Blue Shield, Cigna Healthcare, and Humana. We are “in-network” with many other insurance companies and insurance networks as well.

TriCare: We have a provider number for Tricare in order to service their members. We are not “in-network” with this company, but the difference in coverage between “in” and “out-of-network” benefits for PPO plans is usually 5% of our billed charges. For Tricare HMO plans, we have been able to service these members because we are often the only provider available for our services.

Medicare: Unfortunately, Medicare does not pay for our products so patients must pay for their medical products by credit card or check prior to order placement and distribution.

  • 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 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. Any possible reimbursement will be mailed directly to the patient.
  • Supplemental Insurance: If Medicare denies a claim, the supplemental insurance will also deny the claim.

Medicare Replacement 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.

Insurance Authorizations

In the event that we are “out-of network” with an insurance company, we will submit an authorization request to be paid “in-network” due to a network deficiency. Since we cannot guarantee an “in-network” approval, the patient will be given the option of having products ordered prior to authorization, however, if unsuccessful, the patient will be subject to “out-of -network” benefits. The Consent Form is required if the patient would like their products ordered prior to authorization. By signing the form, the patient is consenting to ordering their products before insurance has agreed to pay. Please make sure the patient has read and understood this form before having them sign it.

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.