Lymphedema - Educate & Take Action

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Written by: Nikki Jensen, vice president, Essentially Women

I want to connect with you to educate you on the importance of contacting your members of Congress to ask for their support of the Lymphedema Treatment Act, H.R. 930 and S. 497.   Why?  Because it matters! 

A little background on why this bill is so important:

Lymphedema is a serious medical condition that has no cure.  When the lymphatic system becomes damaged or impaired the body cannot effectively remove the protein-rich fluid called albumin from our tissues.  The result is swelling of the affected area.   Without proper treatment, patients are at higher risk for developing infections since this fluid is a breeding ground for bacteria.  Infections can lead to hospitalization and increased medical costs.  Early treatment helps to minimize the progression and severity of the disease.     

Breast cancer survivors are at higher risk of developing lymphedema due to the nature of treatment.  Often lymph nodes under the arm are removed during surgery or can become damaged during radiation treatment.    

The first line treatment and most effective way to manage lymphedema is compression garments.  A flexible fabric that has gradient pressure to help keep the fluid moving out of the affected area.   You would naturally assume these physician prescribed compression garments are covered under a private insurance, Medicaid or Medicare plan.  Not the case for most patients.  Currently Medicare does not cover compression garments.  There are codes and fee schedules established, but no coverage.  Many health plans, including state Medicaid plans follow the lead of Medicare.  This means most patients are left to pay out of their own pocket. 

The Lymphedema Treatment Act organization has done a wonderful job leading the charge to help get legislation introduced and passed so patients don’t have to carry the burden of paying for compression garments out of their own pocket.   

Imagine this scenario: 

You are a breast cancer survivor.  After a long and emotional journey, your fighting spirit has carried you through!  You, your family and friends all breathe a collective sigh of relief – everything looks good.  Then one day, out-of-the-blue your arm starts to swell.  It itches a little so you go to the doctor wondering if you have a bug bite or allergy reaction.  To your surprise, the doctor says it’s lymphedema.  You are even more shocked when you find out your insurance doesn’t cover the treatment.  The average out-of-pocket cost for one off-the-shelf compression sleeve is $140.  You need one to wash and one to wear.  Since the fabric will breakdown overtime and lose elasticity, it’s recommended to replace every six months.   If you don’t wear the compression garment, you place yourself at higher risk of developing complications like infections.  Serious infections will lead to hospitalization, which will cost thousands of dollars.  After everything you’ve gone through with your cancer treatments you can’t believe you’ll now be concerned about managing your lymphedema for the rest of your life!

Getting Medicare coverage for lymphedema:

The best way to help patients with access to coverage for compression is to contact your elected officials to tell them this is important.  Contacting members of Congress is easier than you think.  Send an email by using this link to enter your address to get information on your elected official or call their office to let their staff know you would like their support for the Lymphedema Treatment Act.   

House of Representatives:  H.R. 930

Senate:  S. 497

Send a letter to Congress

1 comment

  • Sharon wilson | Mar 7th 2018 @ 12:25 PM

    Just spent 2 days on Hill lobbying for the Lymphedema treatment act. We got 6 new cosponsors and lots of prospects. We still need lots of congressmen onboard. Please setup petitions for your customers to sign. Start filing claims to Medicare with signed ABN onfile. Let them start seeing the number of people who need this. Most companies are not filling claims just having customer pay cash. Let Flood these jurisdictions with compression claims. Be sure to use primary and secondary Icd-10 codes. W

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