Darla K
Jan 20 2003, 04:35 PM
I have a client who is trying to claim reimbursement for a specialized pantyhose that puts pressure on her legs to remover her spider veins.
Is this eligible for reimbursement?
GBurns
Jan 20 2003, 07:28 PM
It depends.
I have had a few clients who got their spider vein and varicose veins surgically treated or removed with approval and payment by BCBS, Aetna and Humana. The various TPAs also paid reimbursement where applicable.
The surgery was regarded as medically necessary because I advised the clients to have symptoms that the Drs could use as a basis for a diagnosis and treatment. Without this it would be cosmetic and not covered.
So the real answer depends on Why and BY Whom? was she given the pantyhose. If she is self treating then it is not reimburseable, If she is being treated by a Dr for medical reasons to alleviate a medical condition etc, then it would be reimburseable.
At first glance it looks like her own self treatment idea, so NO.
Darla K
Jan 21 2003, 09:00 AM
Thank you for your help GBurns that is what we figured and we found out later that it was due to a medical reason and she is going to be having surgery in the near future.