Lymphedema Treatment: Insurance Coverage Reporting Form

The information you provide will assist the Lymphedema Advocacy Group in better understanding the overall insurance coverage landscape for lymphedema treatment supplies and services.

Responses will be kept confidential and results of this survey will only be shared in aggregate, to assist lymphedema patients in choosing insurance policies that provide the best coverage.

To learn more about our group or to contact us, please visit our website.

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* 1. Your Name

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* 2. Your Email (in case we have any follow-up questions)

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* 3. Your State

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* 4. State in which your insurance policy is based, if different from the state you live in.

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* 5. What type of insurance do you have?
Select your primary insurance type, if you have more than one policy.

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* 6. If you have a Medicare Advantage plan, a Medicaid Managed Care plan, or any other type of Private Insurance plan, what company administers it?
For example, United Health Care, Aetna, etc.

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* 7. If you have Private Insurance, what type of policy is it?

Health Maintenance Organization (HMO)

Preferred Provider Organizations (PPO)

Exclusive Provider Organization (EPO)

Point-of-Service (POS)

I don't know

Other (please clarify in comments)

If you selected other, please describe what type of plan you have.

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* 8. What lymphedema treatment supply or service have you received coverage for? Please check all that apply.

Compression bandages

Compression garments

Compression wraps with adjustable straps

Nighttime compression

Compression accessories (i.e., donning & doffing, zipper)

Compression pump

Complete decongestive therapy/manual lymphatic drainage

Lymphedema-related surgery

Other (please clarify in comments)

Please describe any item or service you have received coverage for that was not included in the list above.

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* 9. This question is about in-network suppliers for compression garments. Please select the answer that best matches your situation.

My plan lacks in-network suppliers for the compression garments I need.

My plan has at least one in-network supplier for the compression garments I need, but it is not my preferred provider.

My plan has a satisfactory number of in-network suppliers who sell the compression garments I need.

I am not sure or have no opinion on this topic.

Other (please specify)

Lymphedema Treatment: Insurance Coverage Reporting Form

Question Title

* 1. Your Name

Question Title

* 2. Your Email (in case we have any follow-up questions)

Question Title

* 3. Your State

Question Title

* 4. State in which your insurance policy is based, if different from the state you live in.

Question Title

* 5. What type of insurance do you have? Select your primary insurance type, if you have more than one policy.

Question Title

* 6. If you have a Medicare Advantage plan, a Medicaid Managed Care plan, or any other type of Private Insurance plan, what company administers it? For example, United Health Care, Aetna, etc.

Question Title

* 7. If you have Private Insurance, what type of policy is it?

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* 8. What lymphedema treatment supply or service have you received coverage for? Please check all that apply.

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* 9. This question is about in-network suppliers for compression garments. Please select the answer that best matches your situation.

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* 10. If you would like to share any additional information about your insurance policy please do so here.

* 5. What type of insurance do you have?
Select your primary insurance type, if you have more than one policy.

* 6. If you have a Medicare Advantage plan, a Medicaid Managed Care plan, or any other type of Private Insurance plan, what company administers it?
For example, United Health Care, Aetna, etc.