Highmark Insurance: Compression Garment Reimbursement Changes

Highmark Blue Cross Blue Shield of Pennsylvania (BCBS PA) covers compression garments for breastfeeding mothers. However, it is unclear if Highmark Insurance is changing its compression garment reimbursements. As of 2024, Medicare will cover the use of graduated compression stockings, adjustable compression wraps, and night-time compression garments for patients with lymphedema. Commercial insurance plans are adjusting their policies to follow Medicare guidelines, but it is important to check specific policies as coverage can vary.

Compression garments for lymphedema

Compression garments are a standard treatment option for lymphedema, a condition characterised by swelling due to a buildup of fluid in the body's tissues. This occurs when there is a disruption in the body's lymphatic system, which is responsible for transporting toxins and fighting infections. Compression garments are tight-fitting clothing that compresses the skin to promote the flow of fluids and increase circulation. They are usually prescribed by a doctor or lymphedema specialist.

Compression garments are an essential aspect of lymphedema management, but many insurance companies won't cover them. Medicare, for example, does not typically cover compression garments for lymphedema. However, as of January 1, 2024, Medicare Part B will cover gradient compression garments (standard and custom-fitted) for patients diagnosed with lymphedema and prescribed by a doctor or healthcare provider. Commercial insurance plans provided through an employer or purchased through the Affordable Care Act are also starting to adjust their policies to follow Medicare guidelines. Therefore, it is essential to check with your specific insurance company to determine your coverage.

When using compression garments for lymphedema, there are a few guidelines to follow. Firstly, compression garments should be kept clean to maintain skin health, and daytime garments should not be worn while sleeping. Secondly, compression garments fit very tightly, so if you are sensitive to tight clothing or have blisters or ulcers, you may need an elastic Velcro strap bandaging system instead. Finally, compression garments can be susceptible to bacterial growth if not cared for properly, so they should be washed regularly to prevent skin infections.

In addition to compression garments, there are other compression therapy options for lymphedema, such as multi-layer bandaging systems and pneumatic compression devices. A lymphedema specialist can help determine the most suitable treatment option for you.

Medicare coverage for compression garments

Medicare will also cover compression stockings for patients with a diagnosis of an active venous stasis ulcer. This requires specific documentation and a prescription for graduated compression stockings with compression levels of 30-40 mmHg or 40-50 mmHg.

Compression garments for lymphedema were not previously covered by Medicare, but advocacy by organisations such as Susan G. Komen led to the Lymphedema Treatment Act being passed in December 2022. This Act created a new benefit category for custom-fitted lymphedema compression garments and other approved items prescribed by a healthcare provider.

Medicare will cover daytime compression garments (3 per affected body part every 6 months) and nighttime compression garments (2 per affected body part every 2 years). They will also cover replacement items if the original is lost, stolen, or irreparably damaged, or if a patient's condition changes (e.g., a change in limb size).

Medicare will not cover compression garments for varicose veins, ulcers, circulation problems, or diabetes. They also do not cover compression garments for lymphedema prevention following cancer surgery.

Breastfeeding Shop's Highmark BCBS PA coverage

The Affordable Care Act (ACA) has changed the landscape for new and non-grandfathered plans, making it easier for expecting and new mothers to get a breast pump and supplies covered by Highmark Blue Cross Blue Shield of Pennsylvania.

The Breastfeeding Shop is an authorized Highmark provider that offers top-rated breast pumps and accessories for free to mothers and soon-to-be mothers. To receive a breast pump from The Breastfeeding Shop, you must fill out a quick breast pump insurance order form and have a prescription from a Highmark-authorized physician, midwife, or nurse practitioner. The Breastfeeding Shop will then help you with any paperwork and filing a claim.

Highmark BCBS PA covers a pump and supplies for every baby. The Breastfeeding Shop offers all types of Highmark-approved breast pumps, including basic manual breast pumps and standard electric breast pumps. Some plans may also cover hospital-grade breast pumps. The Breastfeeding Shop also offers maternity compression garments, as well as premier pumps, compression, accessories, and supplies from top-of-the-line manufacturers, all covered through health insurance plans.

Highmark BCBS PA insurance coverage requires a prescription from a Highmark BCBS PA authorized provider, which can include an MD, a nurse practitioner, a nurse, a midwife, or another licensed prescriber.

Highmark BCBS PA Breast Pump Reimbursement and coverage include certain replacement parts and pump supplies for manual and standard electric pumps. This ensures that you can extend the life of your pump and keep every component in working order.

The Breastfeeding Shop is dedicated to supporting families and providing the maximum amount of breastfeeding options through insurance. They also offer free time with lactation consultants.

Compression garments for diabetes

Compression garments are an important aspect of diabetes management, as the condition often causes circulation problems that can lead to swelling in the feet, ankles, and legs (known as peripheral edema). This swelling can interfere with the healing process of wounds and cause discomfort for diabetic individuals. Compression stockings can help to alleviate and prevent this swelling, improving blood flow and reducing the risk of blood clots and other complications.

Diabetic compression stockings are specially designed to be soft and seamless, so as not to irritate the skin. They are typically made from high-quality Lycra fibres with extreme wear resistance and are latex-free. They also have a thick, padded sole to protect the feet, a non-irritating toe seam, and a non-binding top band. Additionally, diabetic socks feature moisture-wicking, anti-microbial fibres to help prevent skin irritations and blisters.

The correct sizing of compression garments is critical to ensuring optimal blood circulation. It is important to avoid garments that are too tight, as this can restrict circulation. For this reason, it is recommended that individuals consult their doctor before purchasing compression garments and monitor their weight to ensure the sizing remains optimal.

While compression garments can help to alleviate the symptoms of diabetes, they cannot address the root causes of the disease. Individuals with diabetes should continue to carefully manage their diet and lifestyle in conjunction with using compression garments.

Compression garments for cancer surgery

Compression garments are an important aspect of recovery after cancer surgery. They can aid in pain relief, blood circulation improvement, swelling reduction, and wound protection. However, it is crucial to prioritise comfort by opting for loose-fitting clothing made from natural fibres like cotton or linen.

Compression garments are often used to manage lymphedema, a common condition that can develop after cancer treatments involving surgery or radiation therapy that damage or remove lymph nodes. Lymphedema is caused by the accumulation of lymph fluid, resulting in swelling. Compression sleeves, gloves, and other garments help alleviate pain and swelling by creating a pressure gradient that redirects fluid flow away from the affected area.

While compression garments are beneficial, they can also be uncomfortable, especially during warm summer months. Additionally, some individuals may find them unattractive. It is important to consult with a certified fitter to ensure the garment fits comfortably and does not worsen symptoms.

Regarding insurance coverage, it is important to note that Medicare will start covering gradient compression garments for individuals diagnosed with lymphedema from January 1, 2024. However, Medicare generally does not cover compression garments for lymphedema prevention following cancer surgery. Commercial insurance plans may provide coverage, but it is important to check with your specific provider as coverage can vary.

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