STATE LEGISLATIVE PACKET (1) BOB WEISS
section includes examples of proposed state laws regarding the
treatment of lymphedema,
the rationale for such a law, an example of a letter to a
legislator, impact analysis of such a law, and copy of a proposed law.
Please remember two points:
1. This should be sent to the legislators in your own district.
2. If you participate in this, please advise me of
your activities so we can track where the laws are
being proposed. We can provide assistance.
You can email me at:
Bob Weiss can be email at: Lymphactivist@aol.com
Special thanks and kudos to Bob for all of his work on our behalf.
TOGETHER WE CAN MAKE A DIFFERENCE
Insurance Coverage for the Treatment of Lymphedema
What is Lymphedema?
Lymphedema is a swelling of a limb and/or part of the body because of a functional inability of the lymphatic system to transport intercellular lymphatic fluid back to the circulatory system. Lymphatic fluid becomes stagnant, leaving the patient prone to infection. When infection occurs, many patients require treatment with antibiotics and costly hospitalization. Lymphedema can affect arms, legs, breast, back, abdomen, groin and genitalia.
Congenital (primary) lymphedema is caused by a malformed or underdeveloped lymphatic system, and can be present at birth, develop at puberty, or occur at older ages.
Secondary lymphedema can be caused by trauma or surgical resection, radiation, infection or disease involving the lymphatic system. The greatest incidence of secondary lymphedema in the United States occurs in cancer patients (breast, melanoma, sarcoma, gynecological, prostate).
30 % of all breast cancer axillary node dissection and inguinal node dissection patients will develop lymphedema over their lifetime.
In the entire United States, of the 203,500 newly diagnosed cases of breast cancer projected for YR2002, 61,000 will develop lymphedema! Also requiring treatment are the survivors of uterine and cervical cancer, prostate cancer and melanoma treatment, adding an estimated 88,500 new lymphedema patients requiring treatment in 2002. (American Cancer Society Facts and Figures 2002.)
The above estimated 149,000 new cases of lymphedema will be added to the millions of existing diagnosed and undiagnosed cases of primary and secondary lymphedema.
How is it treated?
Treatment procedures have been developed in Europe over the last 30 years, but have only been accepted by American medicine for the last 10 years. The current standard of treatment for lymphedema is called "complex or complete decongestive therapy," and it has been the recommended protocol in Europe since 1995 (International Society of Lymphology) and in the U.S. since 1998 (American Cancer Society Lymphedema Workshop). The American Physical Therapy Association (APTA), Guide to Physical Therapy Practice, recommends typically 5 -24 sessions be performed for acute management and periodic follow up as indicated. The acute treatment program consists of manual lymph drainage, low-stretch bandaging, exercise, skin care, and instruction in self-management, including the fitting and procurement of compression garments, bandages and devices. Phase 2 of the treatment program, the home treatment phase, continues for the life of the patient, and consists of self-manual lymph drainage, day-time compression garments, night-time bandaging with multi-layer low-stretch bandages or manually-adjustable compression devices, skin care and exercise while under compression.
Why is insurance coverage needed?
Medicare has no national medical policy for the treatment of lymphedema and routinely denies coverage for components of the currently accepted treatment. Many patients have had Medicare denials for compression bandage systems and compression garments reversed by Medicare Administrative Law Judges, but only after many expensive appeals. Only twenty three states require all private health insurers to provide lymphedema coverage for breast cancer survivors.
Many medical providers fail to provide medical treatment to the current recommended standard of care partly because of lack of knowledge of the current medical standard of treatment for lymphedema, and partly because they do not understand the favorable economics of lymphedema treatment.
There is currently no law mandating treatment of lymphedema from causes other than breast cancer.
Currently in many private insurance companies limit the number of treatment visits and/or do not cover compression garments, bandages, and devices. Insurers should at the minimum provide the minimal standard of care as outlined by the APTA-Physical Therapy Practice and provide replacements of compression orthotics to encourage patient compliance with their lymphedema treatment plan.
What is the cost of mandating lymphedema treatment?
Treatment of lymphedema can shown to save significant amounts of money for the medical provider, the State and the patient. For example, savings in medical expenses over a forty year survival lifetime for treating a woman diagnosed with breast cancer at age 40 has been estimated at close to $400,000.
Treatment of lymphedema has been shown to reduce and/or eliminate the incidence of infection (cellulitis and lymphangitis) encouraged by stagnant lymph.
By reducing the number of hospital admissions and doctor visits, providers will see reduced cost. It can be demonstrated that proper treatment of lymphedema and compliance by patients with daily protocols is not only good medicine, but it is good business and a cost saving tool for insurance companies!
Proper treatment and management of lymphedema can enable patients living with lymphedema to continue to live productive lives.
For More Information Contact :
American Cancer Society www.cancer.org (Keyword Search: Lymphedema)
National Lymphedema Network www.lymphenet.org
Robert Weiss LymphActivist@aol.com
The foregoing are the opinions of Robert Weiss, who is neither trained nor licensed to practice medicine or law. They are the logical result of reading selected medical and legislative sources, and are presented to initiate further thought, research and deliberation.
I am available to provide backup to my assertions, medical and legal references, and cost-efficacy analyses, and to help in any way I can in the drafting and supporting legislation for the treatment of lymphedema.
Robert Weiss, Northridge, CA
LymphActivist@aol.com, Tel: 818-368-6340, Fax: 818-368-6432
Join us as we work for lymphedema patients everywehere:
Advocates for Lymphedema
Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.
Lymphedema People / Advocates for Lymphedema
Lymphedema People New Wiki Pages
you seen our new
“Wiki” pages yet? Listed
are just a sample of the more than 140 pages now listed in our Wiki
are also working on hundred more.
and take a stroll!
are not for
Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)
to Treat a Lymphedema
para-aortic lymph node dissection (EPLND)
Needle Biopsy - Fine Needle Aspiration
Lymphedema Gene VEGFC
Lymphedema Gene SOX18
Home page: Lymphedema People
Page Updated: Dec. 17, 2011