The records have been reviewed. The member is an adult female with a birth date of 10/11/1955. The member has a diagnosis of lymphedema. Her provider, Kellie Lane, MD, recommended a pneumatic compression device for treatment.
The carrier has denied coverage of pneumatic compression device as not medically necessary. There is a letter from the carrier to the member dated 08/19/2016 which states:
“We received a request to review service(s) to be provided to you beginning on 10/26/2015 by Tactile Systems Technology, 1331 Tyler Street Northeast Suite 200, Minneapolis, MN 55413. We have denied this request after thoroughly reviewing all available information.
This decision was based on:
• A physician review. Not Medically Necessary based on Humana Medical Coverage Policy- Lymphedema – Diagnosis and Treatment”
A letter from the member dated 12/04/2015 states:
“ For over 20 years I have dealt with vascular & circulatory issues including surgical vein stripping, phlebectomies, sclerotherapy, radiofrequesncy ablation of veins of both my legs, (3) cerebral strokes and blood clotting issues, all of which resulted in prolonged hospital stays, many hours & days of missed work and even ‘survival’ issues at home because I live alone…
In a period of less than a year, circulation and …show more content…
Compression garments have been widely used in the treatment of lymphedema. These garments may be elastic and non-elastic, and may be used alone or in combination with other treatments. They are used for the purpose of preventing an increase in lymphedema and maintaining the reduction of lymphedema after treatment. If there was evidence of failure after an adequate trial of elevation and use of compression garments, a trial of management with a compression pump could be
The carrier has denied coverage of pneumatic compression device as not medically necessary. There is a letter from the carrier to the member dated 08/19/2016 which states:
“We received a request to review service(s) to be provided to you beginning on 10/26/2015 by Tactile Systems Technology, 1331 Tyler Street Northeast Suite 200, Minneapolis, MN 55413. We have denied this request after thoroughly reviewing all available information.
This decision was based on:
• A physician review. Not Medically Necessary based on Humana Medical Coverage Policy- Lymphedema – Diagnosis and Treatment”
A letter from the member dated 12/04/2015 states:
“ For over 20 years I have dealt with vascular & circulatory issues including surgical vein stripping, phlebectomies, sclerotherapy, radiofrequesncy ablation of veins of both my legs, (3) cerebral strokes and blood clotting issues, all of which resulted in prolonged hospital stays, many hours & days of missed work and even ‘survival’ issues at home because I live alone…
In a period of less than a year, circulation and …show more content…
Compression garments have been widely used in the treatment of lymphedema. These garments may be elastic and non-elastic, and may be used alone or in combination with other treatments. They are used for the purpose of preventing an increase in lymphedema and maintaining the reduction of lymphedema after treatment. If there was evidence of failure after an adequate trial of elevation and use of compression garments, a trial of management with a compression pump could be