Insurance Coverage ?

[2Day]

I recently had a serious exacerbation of primary lymphedema that I've had all my life. It was never a life-limiting problem for me until now, but after I had knee surgery - BOOM - balloon legs, especially the one that was operated on, and a great deal of pain that is worse whenever the swelling is worse.
Because of this I had to quit my job, which required 8-10 hrs/day on my feet. I found another job where I will be able to sit, stand, move around or be on/off my feet, as necessary -- about which I am very glad, because I have to work. I am divorced and have no other income except my own paycheck. But there really was no other choice besides changing jobs. I could not continue in my old job with the amount of swelling and pain I was having.
Okay, so that problem is solved. But now that I am changing jobs I am faced with a 1-year exclusion for pre-existing conditions in my new health insurance coverage.
This is particularly distressing because I've never really needed aggressive treatment for Lymphedema before, but now that I apparently need it (and know very little about it) I don't have health insurance that will cover it any more.
Does anyone have any experience dealing with "pre-existing conditions" exclusions when changing jobs and health insurance?
I can't believe I am the only person who ever had this problem. It seems like it would be a problem for anyone with a chronic health problem who ever changed jobs.
I'm hoping there is a way to deal with this, that I just don't know about yet. (???) :confused:
Thanks for any info or thoughts!

[steveb]

Since this is such a late reply to your insurance issues, I need to know if you ever got it resolved.
Pre-existing laws vary from state to state.
Typically, you need to go without treatment/diagnosis for at least 2 years.
I know, it does stink!
If your employer allowed you to keep your insurance, under COBRA laws, you should be ok. Also, you should've gotten a letter showing "certification of coverage." This is an old law--now-- that absolutely requires insurance providers to provide you with a new policy. THIS IS U.S. Federal LAW, THEY HAVE TO GIVE YOU COVERAGE!!!!!!!!!!
If however, you let that letter slip by the way side, then I'm sorry to say, after 63 days, you're out of luck.
Typically, you get 18 months of coverage you must pay for, out of your pocket. Once you're approved for SSDI, it increases to 29 months. This gives you the chance to get on Medicare. Of course, Medicare doesn't pay for stockings, but I believe they do pay to a lesser degree for MDT.
Keeping your former employer's COBRA coverage is still best. As expensive as it can be-- try as hard as you can to keep it!
If you live in Virginia, there is a law that provides for LE coverage. Laws are popping up all over the place now for LE insurance coverages.

[jlk1973]

Does anyone have a trick on how to get insurance to pay for my garments? I just got my EOB and it's classified as a Non-covered service. At $500 a time and twice a year, that's going to add up to way to much!

I would appreciate any suggestions!

Thanks

[steveb]

If your insurance is unwilling to pay for them start here:
1- tell your doctor to contact them with a "medically necessary" note.
2- If they still deny them, make a phone call and explain to them that they can either pay for stockings, or pay for an amputation-- leave the ball in their court. This has worked for me. They only have to hear that once.
3- Appeal the denial through normal procedures.
4- Contact Robert Weiss. He's an LE advocate lobbying for changes in the laws. He has told me on a few occasions that he'd help file appeals. He's a retired engineer, and has excellent communication skills to accomplish this.
5- call your federal congressman/woman, and senators. Let them know that this is happening to you. Tell them you need this, or could be faced with a loss of employabilty, and therefore a loss of livelihood, and possible amputation. Losing taxes, and paying more out through disability incomes always bothers them.
Another contact would be Cyndi Ortiz. She's also lobbying for LE legistlative changes.
Both Robert's, and Cyndi's contact info should be listed on this site somewhere, or can be obtained through the mgmt.
If not, send me a pm, and I'll get them to you.
That you're facing this is not a new issue.
Some of us have banded together to make congress stand up and notice us.
first, though, I'd start with some phone calls to your doctors, insurance co, and the above notes.
I lost my 12 year career because of LE, and Medicare thinks it's all a good laugh, and are "just following the rules."
As for access to your senators, and congresspersons, go to the following.
www.senate.gov
www.house.gov.
Place your zipcode in the option, and you will be directed to your specific reps' web pages.
Then look for contact info.
Also, if interested, the House Ways, and Means committee handles Medicare laws governing coverages-- if you're on Medicare.
The Health subcommittee is also listed, and shows all of the congress-persons who would be involved in this process.
Your congressperson might be one of them. If so-- please make them aware of this.
Votes do count, and if they don't want to help you-- make them aware.
All of your reps will have health care liaisons to assist you.
Keep us apprised.

[Cyndspitz]

Does anybody know if Medicare covers any treatments centers. If so, where?

[Ann]

Medicare will cover lymphedema treatment with certain restrictions.

In outpatient facilities Medicare has determined that nurses and massage therapists, no matter how well qualified they may be, are not allowed to treat lymphedema therapists.

To better understand this confusing situation, read the articles under the heading of "Insurance and Medicare.

Ann

[asmarcus]

I had massages when I had my treatments and both Medicare and my secondary insurance paid for them I believe. It wasn't written as massage therapy though.

Ann M