Back in July we notified plan sponsors and advisors, in The Advantage, that we were looking at the way we adjudicate compression stocking claims and we were making a change. This change is taking place next week so I just wanted to bring it to your attention.
The market for compression stockings has been growing, which has resulted in increased utilization / claims experience over the past couple of years. In 2017 GSC paid out more than $22 million for compression stocking claims, an increase of 18% over the past 5 years.
Compression stockings have always been paid based on the compression level of the stocking (mmhg). After an extensive analysis and review by the Health Services and Benefits Management and Investigation Services (BMIS) teams we have determined that the cost of a knee length stocking versus the cost of a full length stocking are considerably different even if they have the same strength. In fact a key finding was that more than 75% of claims are for the less costly knee length stocking. As a result it was determined that our guidelines and policies for this benefit could be improved, bringing the length of the stocking into consideration. It was also determined that footless calf sleeves are being sold as compression stockings, when infact footless calf sleeves aren’t eligible for reimbursement.
As a result, effective September 25th, 2018, all compression stocking claims will be processed based on the compression level, length (knee / thigh/ full) and the type (footless / sock / tights). New R&C limits have been established for knee length socks under each of the compression levels. Eighty-five percent of compression stockings are for the strengths of 20 – 29 mmhg.
Please note that any existing administrative rules under your programs (ie: frequencies) will remain in place.
In August we began notifying providers and plan members of this change. We have also conducted an email campaign with providers to make them aware of the change.
Later this week we are sending an email to all plan members who have claimed compression stockings in the last 12 months to remind them of the change.
Alternatively, speak with Beneplan to set up a call with us.