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Lymphedema Bills

© Linda Bily

Insurance coverage for lymphedema therapy is desperately needed for many patients. The current policy limitations are vague and insufficient. Bob Weiss, long time LE advocate and the most knowledgable man I know on this area of LE, has posted some excellent information on Lymphedema People. There is also a new bill that has caught the attention of several congressmen and needs your input and support.

I am going to quote Bob's post in its entirety this month and urge you to read it, check the links and write to your legislatures. We can't complain about lack of LE legislation or insurance coverage if we don't participate in the push on the politicians!

Can we afford to wait two more years for lymphedema treatment and coverage legislation?"

While the Federal bill is being worked on in Washington, we can and should proceed at the state level as well.

Bob Weiss summoned it up so well in his post to the group:

FOCUS ONLY ON FEDERAL LEGISLATION ONLY

FOCUS ON BOTH STATE AND FEDERAL LEGISLATION

FOCUS ONLY ON STATE LEGISLATION

REASON:

Which of the three is really best and most needed.

In brief, I believe that we must focus on Federal AND State legislation.

Our medical coverage arises from many sources, governed by different laws. Among the major sources of coverage are: Medicare--Title XVIII SSA; Medicaid--Title XIX SSA + State Law; Non Self-funded Employee Health Plan--State Law; Self-funded Employee Health Plan--ERISA; Private Insurance--State Law; Church Employer--State Law; Federal Government Employee--FEHBA; State Government Employee--State Laws.

Since Medicare reimbursement sets the pattern for insurance reimbursement, most insurance companies follow the Medicare policies for their reimbursements--even of non-Medicare coverage. So any improvement in Medicare coverage is likely to result in improvements even in non-Medicare coverage. Changes to the SSA result in policy changes on a national level, and local or regional (State) contractors are bound to implement local changes in consonance with the national policies. So Medicare has an influence far greater than just the number of Medicare beneficiaries.

But Medicare is in deep financial trouble, and it is unlikely that changes to the SSA will be considered in Congress for the next few years while the effects of the Prescription Drug and Medicare Modernization Act (MMA) are still not known and the policies are being written. Especially any changes that impose $1.00 additional budget on the system. I believe our strategy should be to show the COST SAVINGS that can be achieved with coverage of lymphedema treatment.

State laws cover private insurace coverage, state employees, HMOs (non-Medicare), church employees and certain employee plans. This is a large enough population that it deserves our attention. And as soon as enough states have (different) lymphedema treatment coverage laws then the pressure builds for a uniform national law. And state law change is doable! Virginia has a lymphedema treatment law. New York and Massachusetts have lymphedema treatment bills that

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