CHANGES to BCBS Fee Schedule

My dear friends,

I need to let you know about some changes for BCBS insureds that went into effect June 1, 2024

SITUATION:

As of June 1^st BCBS slashed reimbursements on Ready To Wear Compression Stockings by 50%-75%.

This change is one of the unintended consequences of the Lymphedema Treatment Act which was actually intended to expand coverage for patients with lymphedema.

The new BCBS fee schedule now only covers the most basic/budget stockings, not the premium stockings we have been providing for most of our clients

As a contracted provider we are required to:

• Provide patients with compression stockings that meet their fee schedule
• Accept BCBS allowed amount (we cannot bill patients for upgrade to premium stockings)

SO:
For BCBS PPO and HMO insureds the only READY TO WEAR stockings we can now bill on are the basic economy lines from Jobst, Juzo, Mediven and Sigvaris.

WHAT THIS  MEANS:

We have FAR fewer sizing options, and no silicone band options in knee high.

AND- because of BCBS contract restrictions- we can not upgrade.

Either the patient fits into a budget stocking or they have to pay completely out of pocket for a premium version.

Which is awful and it going to cause a lot of upset for patients who until now have been getting premium stockings covered.

MOVING FORWARD IN THIS NEW ENVIRONMENT:

We will make every attempt to fit patients into stockings covered by their insurance.

We are upping our inventory of the economy lines and hope/think that we can make this work for most patients.

Some good news- if a patient does not fit well into a Ready To Wear stocking we can offer custom made options for them.

(We CAN still bill BCBS for custom made stockings)

 *NOTE- Velcro Wraps, Compression Arm Sleeves and Custom Made Garments are currently NOT significantly affected by the new fee schedule and we can continue to fit those as we have in the past.

I hope this explains everything – it’s a difficult situation but we will do our best to help you navigate it.

Any questions- let me know?

And as always – thank you for your support!

CB

Announcement

Dear friends,

Effective January 1, 2024- The Lymphedema Treatment Act requires Medicare to provide coverage for compression for patients diagnosed with lymphedema.
Patients with other diagnosis (i.e. venous insufficiency, edema, varicose veins) are NOT eligible for Medicare coverage.
In order for lymphedema patients to qualify for coverage for compression garments they MUST present at the time of their fitting a written order that includes ALL of the following elements:

Patient’s Name
Order date
Description of compression garment ordered including level of compression
Quantity to be dispensed
Qualifying Diagnosis
Practitioner’s name (printed, typed or stamped)
Practitioner’s signature

Medicare patients will be required to pay for non-custom garments when you receive them.
Medicare patients will be required to pay for custom garments at the time they are ordered.
We will file a claim with Medicare for your reimbursement.
The reimbursement will range between 60% to 100% of the cost of the items purchased.
Medicare requires medical records to substantiate the need for all compression garments so before your claim can be filed for reimbursement you will need to provide clinical notes from your therapist or doctor demonstrating the need for compression garments.
For custom made stockings you will need to provide documentation from a healthcare provider detailing the reasons you are unable to use ready to wear compression garments.
Alternatively – If you are not able to provide those records you will be required to sign a document stating that you may not qualify for coverage.

PLEASE NOTE THAT THIS INFORMATION APPLIES ONLY TO MEDICARE PATIENTS.
We will continue to bill BCBS and Aetna claims as we have in the past and there are no limits to qualifying conditions for those insurances.

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We invite you to visit our specialty support wear shop, the only one of its kind in the Chicago metropolitan area. When you enter you will find a welcoming staff, highly experienced fitters and an astonishing variety of medical compression and support wear. We begin your fitting by reviewing your physicians orders and talking to you about any special requests or limitations you might have. Next we make sure that you are measured correctly and are fitted with a high quality garment that best meets your specific needs. You will also receive appropriate instruction in how to apply and remove your compression wear without damaging either the garment- or yourself.

To provide us with the time we need and the attention you deserve we recommend that you call first to make an appointment. A first time fitting will take between 30 and 45 minutes- during which time you will have an opportunity to try on your garments for fit and comfort before you are committed to them. And you may be surprised to find that your properly fit compression garment actually feels really good!

So- come in and see us, we’ll take the scare out of compression wear.

 COME IN – GET FIT – FEEL BETTER!