Insurance - Elvarex Garment

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Insurance - Elvarex Garment

Postby carmella56 » Mon Oct 22, 2007 12:02 pm

Hello All,
I am new to this website . I'm having problems in getting my Elvarex garment. Seems many of the providers for these will not bill Blue Cross (or other insurance companies) because they only get a specific allotted amount for Compression garments.... So even though I have a list of providers who are supposedly contracted with Blue Cross . When I go in to get fitted they're all saying they will not bill Blue Cross because they lose money since they only get approx. 25% of the cost of this garment. Is anyone having this problem? BCBS told me I'd haveto contact the AMA and ask them to create a code which will allow for a greater payment for providers to be made on custom garments. Like the AMA is really going to do that for me....I'm very upset because these providers want me to pay in advance. Of course I do not have that kind of money and now am playing this insurance game. Any ideas or suggestions out there?

Carmella56

THANKS MUCH
carmella56
 
Posts: 2
Joined: Mon Oct 08, 2007 4:12 pm

Postby Seattle Gal » Fri Nov 09, 2007 8:19 pm

Hi Carmella,

I have been getting compression garments for the last several years and all have been covered by Premera Blue Cross under the durable medical equipment part of my coverage. I live in Washington state. My provider gets paid the billed cost less the 20% I am required to pay. There has to be a billing code for this type of garment with the provider. Do some investigating and see if they are billing it under the wrong part of your coverage. If providers only got reimbursed 25% of the actual no one would be willing to provide them. My last socks cost $440 for knee high custom made socks. I paid $88 and the insurance company paid the rest. You might try the insurance commissioners' office in your state for some help.

Also see if you can find the medicare code for the socks most insurance plans use the same billing codes as medicare and medicaid. They are the standard for accepting procedures etc. I believe they are covere under medicare but you are limited to something like 2 pairs a year.

Beverly
Seattle Gal
 
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Joined: Mon Jun 12, 2006 12:15 pm

Stocking

Postby carmella56 » Mon Nov 12, 2007 2:00 pm

Thanks much for your reply to my question. I finally found someone who would order this and bill BCBS, however, I'm finding more and more suppliers of Elvarex that want payment PRIOR to ordering because they say they get ripped off by insurance. My last Elvarex garment was $700 and suppliers claim BCBS is only reimbursing them for an allowed amount of $200. Suppliers are saying that insurance companies categorize the Elvarex and the Jobst as the same garment. I find that hard to beleive. I can't seem to find anyone who can confirm what the code is and what the Customary Allowed amounts are?

Thanks again.
Mary W
carmella56
 
Posts: 2
Joined: Mon Oct 08, 2007 4:12 pm

Postby Seattle Gal » Mon Nov 12, 2007 2:21 pm

Hi Carmella,

My understanding is that Jobst is the company name and Elvarex is one of their lines, the preferred one by many therapists. They make other stockings other than the Elvarex one. Have you called the insurance company directly and asked for this information? Better yet put the question in writing. I still wonder if they are billing it under the wrong part of your insurance. Do you have coverage for durable medical equipment? They should fall under that category and usually they pay fairly well. You should also try your insurance commissioner's office as they should have a consumer advocate who could help you with this issue.

It is a big hassle I know. I am lucky and have never had to fight this battle. I don't give up without a fight!

Beverly
Seattle Gal
 
Posts: 12
Joined: Mon Jun 12, 2006 12:15 pm


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