Other sources of help

Private health insurance reimbursements

Here are strategies and ways to obtain maximum reimbursement from insurance companies and the government for costs related to lymphedema treatments and medical supplies required during and after treatment.

Treatment reimbursement

Make an inventory of the specialists who can be certified in lymphedema treatment covered by your insurance policy: i.e., massage therapist, physiotherapist, occupational therapist, physical rehabilitation therapist, physiotherapy technologist, PRIVATE PRACTICE nurse, kinesiologist, kinesitherapist, orthotherapist.
Ask your private insurer about the services that can be claimed.
Find out about the procedure for obtaining treatment approval.
Make sure you have a doctor’s prescription for treatment.
Important: teamwork between you, your doctor and your therapist is essential. Ask questions: How many treatments per week? For how many months? What is the expected evolution? Why are the treatments necessary? By receiving these elements in a structured application, insurers can assess and, above all, give you a more precise answer.
Have your treating physician and lymphedema therapist complete all paper insurance forms?
When sending the application to the insurer, include a letter explaining the need for treatment. Photographs of the condition of your affected limb help to explain the need for treatment.
If your claim is rejected, don’t give up hope. Requests for review, adjustment and correction can be made to your insurer. Ask why your request was denied. Sometimes it’s simply a question of adjustments to the form or missing information. Send it again with the corrections.
Another strategy to reduce the financial impact: start processing at the end of the current year.

Reimbursement of day, night and non-elastic compression garments – velcro (Orthesis)

Check the conditions of your insurance policy.
Obtain a duly completed medical prescription to avoid paying taxes and to be able to submit a claim to your private insurer (for the amount reimbursed by RAMQ).
On the supplier’s invoice, request that compression garments be identified as orthoses or orthopedic/orthotic material.
Most insurance programs cover up to 80% of the cost of 2 to 4 garments per year or more, or 80% of the amount not reimbursed by RAMQ (reste à charge).
With a medical prescription, it is possible to obtain more than the minimum indicated in the insurance contract.
When you order your compression garment, your fitter will place the order with the manufacturer and send the claim to RAMQ.
A deposit may be required. Pay the balance only when you pick up your garment.
Claim from your private insurer the remaining amount not reimbursed by RAMQ. Part of this amount (up to 80%) will be reimbursed by the insurer.
If you exceed the number of compression garments included in the RAMQ program, you will need to provide proof of refusal from RAMQ in order to have your excess garments reimbursed by your private insurer.

Bandages / Orthopedic / orthotic support

Attach your medical prescription
Letter from attending physician and therapist (ONCE ONLY) for initial claim.
Add any information on the need for compression and photos
Your therapist can help you fill out the form.
Even if the cost of your bandages exceeds the amount allowed by the RAMQ, it is essential that you submit all invoices for the costs incurred in purchasing your bandages.
Claim from your private insurer the residual amount not reimbursed by RAMQ. Part of this amount (up to 80%) will be reimbursed by the insurer.

Additional strategies

Coverage under private insurance policies varies, as it is based on agreements negotiated with each company.

Don’t give up if your application is rejected.

Contact an agent
Gather as much information as possible on the subject
Send all relevant prescriptions
Read carefully what the insurance program covers
Talk to your employer
Send photos

Other possibilities for reimbursement or financial assistance

Community organizations (see below)
Québec Breast Cancer Foundation – see eligibility criteria
Employer
Family members
Private hospital funds
Insurance company ombudsman
Autorité des marchés financiers – insurance regulator for Québec
Social assistance

Community organizations

If you’re in financial difficulty, one of these organizations may be able to help you access lymphedema treatment, depending on where you live.

CENTRE D’ACTION BÉNÉVOLE DU BAS-RICHELIEU
relié au cancer
RÉGION : Sorel-Tracy
Tél. : 450-743-4310
www.cab-basrichelieu.org

FONDATION CLAUDE DUROCHER
relié au cancer, excluant le cancer du sein
RÉGION : Estrie
Tél. : 819 345-4624
www.fondationclaudedurocher.com

FONDATION DU CANCER DU SEIN DU QUÉBEC
RÉGION : Tout le Québec
Tél. : 514 871-1717
Sans frais : 1 877 990-7171
www.rubanrose.org

LES ROSES POUR LA CAUSE
RÉGION : Lac-Mégantic
Tél. : 819 214-ROSE (7673)
https://lesrosespourlacause.ca

MAISON MAIN…TENIR L’ESPOIR
RÉGION : Trois-Rivières,
Mauricie/Centre-du-Québec
Tél. : 819 909-7443
www.maisonmaintenirlespoir.com

MAISON VICTOR-GADBOIS
cancer stade 4, fonctionnel
RÉGION : Montérégie
Tél. : 450-467-1710
www.maisonvictorgadbois.com

MISSION TOURNESOL
Centre Inspire la vie
RÉGION : Abitibi-Témiscamingue
Tél. : 819-290-4572
www.missiontournesol.com

PROJET SAFIR
cancer du sein seulement
RÉGION : Tout le Québec
Tél. : 514-461-2088
Téléc. : 1 450-748-0598
www.fjmp.org/fr/safir

SE RECONSTRUIRE,
CENTRE DE SANTÉ DU SEIN
RÉGION : Longueuil, Montérégie
Tél. : 438-527-SEIN (7346) https://www.centresereconstruire.ca/

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