Does Insurance Cover Compression Stockings?

Compression stockings are specialized garments designed to apply graduated pressure to the legs, assisting with blood circulation and reducing swelling. These stockings are often recommended by medical professionals for various conditions that affect blood flow in the lower limbs. While they may appear similar to regular socks, compression stockings serve a distinct medical purpose, aiming to improve venous return and alleviate discomfort. The question of whether health insurance covers these items is a common inquiry for many individuals seeking to manage their health conditions.

Criteria for Insurance Coverage

Insurance providers typically cover compression stockings when medically necessary for a specific health condition. They are often classified as Durable Medical Equipment (DME), which includes items used in the home to aid a medical condition. For compression stockings to qualify as DME, they must be prescribed by a physician and meet certain specifications regarding their pressure and purpose.

Common medical conditions that may warrant insurance coverage include chronic venous insufficiency, lymphedema, and deep vein thrombosis (DVT) prevention. For example, Medicare Part B may cover stockings if used to treat an open venous stasis ulcer or for lymphedema, with specific stipulations on compression level and type. Different insurance plans, such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Medicare, and Medicaid, have their own guidelines for DME coverage, but the underlying principle of medical necessity remains consistent.

Confirming Your Specific Policy Benefits

Understanding your specific insurance policy’s coverage is important. Policyholders should contact their insurance provider directly, using the phone number on their insurance card or their online portal. When speaking with a representative, ask several specific questions to clarify benefits.

Inquire whether Durable Medical Equipment (DME) is covered and what the applicable deductibles, co-pays, and co-insurance amounts are for DME. Determine if prior authorization is required for compression stockings and if specific in-network DME suppliers must be used. Review policy documents, such as the Summary of Benefits and Coverage (SBC), for additional details regarding coverage limitations and exclusions. This helps prepare individuals for obtaining their prescribed stockings.

Obtaining a Medical Prescription and Preparing the Request

A formal prescription from a medical professional is a prerequisite for insurance coverage of compression stockings. This prescription should originate from a consultation where a medical professional provides an accurate diagnosis. The prescription must contain specific, detailed information to satisfy insurance requirements.

This includes the precise diagnosis code, often an ICD-10 code, which justifies the medical necessity for the stockings. The prescription should also specify the exact type of compression stocking, such as knee-high or thigh-high, the required compression pressure (e.g., 20-30 mmHg or 30-40 mmHg), and the recommended frequency of replacement. If prior authorization is necessary, the physician’s office will typically need to complete forms that include patient demographics, physician details, and clinical notes supporting the medical necessity.

Submitting for Approval and Acquiring Your Stockings

After preparing all necessary documentation, including the medical prescription and any required prior authorization forms, submit the request for insurance approval. Submission can be handled through online portals, fax, or mail, often facilitated by the physician’s office or DME supplier. Expect a processing time of a few days to several weeks.

Following approval, acquire the compression stockings from an in-network DME supplier or pharmacy, identified through your insurance provider or a Medicare online tool. The DME supplier will bill your insurance directly, and you will be responsible for any remaining out-of-pocket costs, such as deductibles, co-pays, or co-insurance.