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eyepopper
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O2 and Insurance
« on: Sep 13th, 2006, 4:54pm » |
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Hi everyone!
I'm an (old) newbie. In other words, I "lurked" on this board for about two years trying to educate myself from others who have visits from the beast.
First, I want to thank everyone who welcomed me in the "Getting to Know You" section of the board. Secondly, I have to thank each and every one of you for your board discussions. This has help me get the information I needed to find and switch to a good neuro and get the help I needed. You don't know how valuable your discussions and advice have been. Thank you, thank you, thank you!
My question is this. I was (finally) able to get a prescription for 02, 10 liters/per min for ten minutes as needed with a non-rebreather mask. The med supply company I called today told me that I was going to have trouble getting insurance (Aetna) to pay for it, because they do not consider Cluster Headaches a medical condition!  . (It's good to know I'm just imagining this pain!!!!!!!!!!!!!!!!!)
Anyway, I'm gonna call Aetna tomorrow, and I'm wondering if any of you had an actual script from a doctor (like I do), but have had trouble with their insurance co.
The med supplly rep said it's $85/mo to rent the tanks, and $26.00 for each refil. He said I could buy the whole set-up (2 tanks - I forgot how big they are) for $285.00. Did any of you simply outright purchase the tanks?
Any advice would be appreciated.
Debby
P.S. I'm chronic and have gone for the past 5 days PF. Usually, I get 4-7 PF days, and then 2 weeks of sheer hell before I get another break. I'll try to read your answers, but if I don't right away, it's 'cause I bit the dust! (Although I do have Imitrex now!) Thanks.
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BB
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Re: O2 and Insurance
« Reply #1 on: Sep 13th, 2006, 6:45pm » |
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Hi Eyepopper
I think you should argue HARD with the insurance company, if you have a script from a doctor then it confirms that you have A medical condition that requires 02 as treatment regardless of what it is. Maybe use the name Neurovascular Cephalagia to see if they recognise it better. People at insurance company aint doctors and are not qualified to make such a decision or diagnosis. But often they have a list of what they go by and if its an old list it may have other names such as Histamine Headaches which is the old name for CH.
Also I think its cheaper to lease the 02 as you wont need it while in remission which  can be years
JMHO.
Take care and painfree wishes to you.
Annette
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E-Double
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Re: O2 and Insurance
« Reply #2 on: Sep 13th, 2006, 7:06pm » |
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No problems.
You can always provide info from here and if they give ya crap ask to speak to their doc on staff
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BigCoffinHunter
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Re: O2 and Insurance
« Reply #3 on: Sep 13th, 2006, 7:12pm » |
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Your doctor should be able to get somewhere with the insurance co. Hell he can write it up as 'migraine' and get the same meds.
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Kevin_M
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Re: O2 and Insurance
« Reply #4 on: Sep 13th, 2006, 8:11pm » |
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on Sep 13th, 2006, 4:54pm, eyepopper wrote:| Anyway, I'm gonna call Aetna tomorrow, and I'm wondering if any of you had an actual script from a doctor (like I do), but have had trouble with their insurance co. |
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This is from the website of Aetna services about oxygen. There is a policy info statement at first:
http://www.aetna.com/cpb/data/CPBA0002.html
D. Other diagnoses for which short-term use of oxygen has been shown to be beneficial (unrelated to hypoxia), e.g., cluster headache may be certified as medically necessary on an individual case basis upon medical review:
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| « Last Edit: Sep 13th, 2006, 8:13pm by Kevin_M » |
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BB
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Re: O2 and Insurance
« Reply #5 on: Sep 13th, 2006, 8:54pm » |
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I forgot to add, ( from a personal experience ), if you ring the doctor and tell him that the insurance company discounted what he wrote, that should upset his ego enough for him to drop everything to ring them pronto and slam them on your behalf 
Annette
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eyepopper
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Re: O2 and Insurance
« Reply #6 on: Sep 13th, 2006, 9:01pm » |
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Ok guys . . . thanks for the ammo. If they give me any crap, I'm gonna try these things. I'll report back later.
You're my lifesavers 
Debby
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Jonny
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Re: O2 and Insurance
« Reply #7 on: Sep 13th, 2006, 9:03pm » |
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Buy a 60 cub welding tank and have it filled at a welding supply house.....fuck the docs and the insurance Co!!!
Its much cheaper!
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It is up to YOU to educate yourself and then help your doctor plan your treatment. If you just sit down in front of your doctor and say "make me better" you are setting yourself up for a great deal of pain.
- Guiseppi
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Jobette
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Re: O2 and Insurance
« Reply #8 on: Sep 13th, 2006, 9:10pm » |
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Before I got my own O2, I was told that welding O2 was no good. Not to say that I agreed because I told O2 was O2. I was just wondering if you have to have a filter or something. 
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Who gave cupid those flaming arrows, and why is he shooting them into my right eye?
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Mr. Happy
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Re: O2 and Insurance
« Reply #9 on: Sep 13th, 2006, 9:28pm » |
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on Sep 13th, 2006, 9:03pm, Jonny wrote:| Buy a 60 cub welding tank and have it filled at a welding supply house.....fuck the docs and the insurance Co!!!Its much cheaper! |
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Not that I want to be considered as "In the same Ballpark" as the long haired one.....but....Agreed.
Get your own stuff. Lots of it. And a Clustermasx.
There's more old CHeads than there are old Docs.
Hap
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TxBasslady
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Re: O2 and Insurance
« Reply #10 on: Sep 13th, 2006, 9:41pm » |
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on Sep 13th, 2006, 9:10pm, Jobette wrote:| Before I got my own O2, I was told that welding O2 was no good. Not to say that I agreed because I told O2 was O2. I was just wondering if you have to have a filter or something. |
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Welder's 02 is the same as medical 02. Whoever told you that is uninformed.
Jean
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BB
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Re: O2 and Insurance
« Reply #11 on: Sep 13th, 2006, 9:48pm » |
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I am not an expert on this but I read somewhere that welder oxygen needs to be humidified otherwise its too dry and can cause sore throat and nose bleeds?
Annette
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TxBasslady
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Re: O2 and Insurance
« Reply #12 on: Sep 13th, 2006, 9:52pm » |
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My insurance paid for my 02..for about 5 months.
They decided it was cheaper to buy the equipment...so they purchased the 4 tanks I have in my possession.
The insurance will still pay for refills...and will guarantee my 02 needs for travel.
I've had very good luck with my insurance provider.
Jean
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Jonny
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Re: O2 and Insurance
« Reply #13 on: Sep 13th, 2006, 9:58pm » |
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on Sep 13th, 2006, 9:48pm, BB wrote:I am not an expert on this but I read somewhere that welder oxygen needs to be humidified otherwise its too dry and can cause sore throat and nose bleeds?
Annette |
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Thats why your not an expert on it, I am
Ive owned a welding company for 15 years, I do have a humidifier but I dont always use it.
Welding 02 and medical 02 are filled from the same main tanks....its the same air.
Welding 02 will NOT work if it is not 100% pure.
Its the tank that you have to worry about, med tanks are inspected....welding tanks are not.
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It is up to YOU to educate yourself and then help your doctor plan your treatment. If you just sit down in front of your doctor and say "make me better" you are setting yourself up for a great deal of pain.
- Guiseppi
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TxBasslady
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Re: O2 and Insurance
« Reply #14 on: Sep 13th, 2006, 10:07pm » |
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on Sep 13th, 2006, 9:48pm, BB wrote:| I am not an expert on this but I read somewhere that welder oxygen needs to be humidified otherwise its too dry and can cause sore throat and nose bleeds? |
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I'm not an expert either...
Any 02 can cause sore throat and nose bleeds and dryness. However, normally you're not on the 02 for long periods.
Welder's 02 is exactly the same as medical 02...
Medical 02 provider's will argue that fact....cause they know you can buy welder's 02 far cheaper than theirs.
They want you to buy from them....they sell it at a premium price.
Welder's 02 has to be as "pure" as medical 02...in order to get a clean weld.
I don't mean to appear to be "arguing" with you.
Read some more here....ask some who have their own set-ups. Jonny and others simply modified the welding tanks in order to fit the proper regulator needed for CH.
Jean
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BB
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Re: O2 and Insurance
« Reply #15 on: Sep 14th, 2006, 1:53am » |
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on Sep 13th, 2006, 9:58pm, Jonny wrote:
Thats why your not an expert on it, I am
Ive owned a welding company for 15 years, I do have a humidifier but I dont always use it.
Welding 02 and medical 02 are filled from the same main tanks....its the same air.
Welding 02 will NOT work if it is not 100% pure.
Its the tank that you have to worry about, med tanks are inspected....welding tanks are not.
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Thanks Jonny for explaining.
Would a normal welding oxgen tank have the same fitting as the medical one? ie can we just buy the welding tank and fit the regulator that we have now and use it ? and how do we "inspect" the welder tank? Is it dangerous to use one if we have no experience on how they work?
Annette
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Jobette
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Re: O2 and Insurance
« Reply #16 on: Sep 14th, 2006, 9:19am » |
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Yeah, Thanks Jonny!  Please tell me how to do it safely.
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| « Last Edit: Sep 14th, 2006, 9:25am by Jobette » |
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Who gave cupid those flaming arrows, and why is he shooting them into my right eye?
Where is his love?
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Mr. Happy
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Re: O2 and Insurance
« Reply #17 on: Sep 14th, 2006, 10:30am » |
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on Sep 14th, 2006, 1:53am, BB wrote:| Would a normal welding oxgen tank have the same fitting as the medical one? ie can we just buy the welding tank and fit the regulator that we have now and use it ? |
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In the US, commercial O2 comes with a 540 fitting (below.)
Here's a link to Aussie info done by Barry Coles.
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Jobette
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Re: O2 and Insurance
« Reply #18 on: Sep 14th, 2006, 11:41pm » |
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So then, Do we just hook on the mask and set the regulator to 8 - 15 and pull like hell? Don't mean to sound dumb.
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Who gave cupid those flaming arrows, and why is he shooting them into my right eye?
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mcf69
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Re: O2 and Insurance
« Reply #19 on: Sep 14th, 2006, 11:55pm » |
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on Sep 14th, 2006, 11:41pm, Jobette wrote:| So then, Do we just hook on the mask and set the regulator to 8 - 15 and pull like hell? Don't mean to sound dumb. |
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Jobette, start at at least 10 lpm, put your finger over the little flap between the mask and bag, alowing the bag to fill up, put it on your face, get a good seal around the edges and breathe. You will find that the bag deflates with each breath and refills as you exhale, if you are breathing hard and sucking the bag down, increase the flow rate in increments up to 15 until you find where you aren't sucking the bag down so much, this will give you the maximum amount of O2. 2 things; don't hold your finger over the flap too long, or the bag will pop, and the higher the flow rate, the more o2 you will use.......
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Jobette
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Re: O2 and Insurance
« Reply #20 on: Sep 15th, 2006, 12:42am » |
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Thanks.
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Who gave cupid those flaming arrows, and why is he shooting them into my right eye?
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TxBasslady
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Re: O2 and Insurance
« Reply #21 on: Sep 15th, 2006, 3:53am » |
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I use a Clustermasx....but when I used the nonrebreather mask, I taped the vents on the mask. Some folks here cover them with their fingers.
The Clustermasx comes with several bags. The bags are much larger than the ones with the nonrebreather.
Ben (w/Clustermasx) taught me how to save alot of 02. You should breathe normal.. and if you do so, the bag will remain inflated. Ben started my regulator at 12...allowed the bag to inflate...had me breathe normally...and after a minute or so, he showed me the setting on my regulator. It was at 8 lpm. I was absolutley amazed! The large bag was still inflated when he turned the regulator off.
You should also sit as straight as possible....this allows the 02 a direct path. If you slump...or lie down, the 02 has to accomodate for your posture/position, and will take longer to work. These pointers from Ben really work...and I've noticed a real difference in the amount of 02 I've used since learning and practicing these techniques.
Huffing and puffing the 02 is alot like hyperventilating. If you can try and remain as calm as possible...and apply Ben's techniques...I think you'll be amazed at how quick the 02 will kick a CH. From start of CH to finish, with a Clustermasx, I can squash a CH in less than 3 minutes. This is a great improvement for me...and the 02 has allowed me to be totally med free..(except for the 02). Some folks consider 02 to be a med..and since it's an abortive, rightfully so. The last Triptan I took was in January, '05.
I'm episodic, but have no cycle. My CH is random and I'm subject to getting hit at anytime the CH desires too.
Good luck with the 02,
Jean
Disclaimer: I do not work for Clustermasx. From experience, it's the best thing I've used for CH. Designed and sold by a Clusterhead in the UK.
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| « Last Edit: Sep 15th, 2006, 3:59am by TxBasslady » |
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Take a kid fishin
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Tom K
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Re: O2 and Insurance
« Reply #22 on: Sep 15th, 2006, 9:08am » |
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Sorry to find this thread so late, I have Aetna and they pay for my O2. Your neuro just needs to put in the right diagnosis number. Aetna has never questioned my O2, they did question my med usage...once. I threatened to call all the news channels during sweeps and they backed off and gave me my meds. Never had a problem after that. HTH
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eyepopper
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Re: O2 and Insurance
« Reply #23 on: Sep 20th, 2006, 9:34am » |
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Hello and Thanks to all:
I just wanted to thank you all for the input about 02. My doc wrote a letter to Aetna, and they're telling me they will cover it. You all had many great suggestions and the support alone has been valuable.
I really want to try the 02, because I know the triptans are probably hard on your heart. I understand that many of you have had success using it.
I'm getting a non-rebreather mask through insurance, but I think I might order the Clustermasx as well, because I understand it's more effective. I checked out the website, and it looks like it might help.
Anyway, thanks again. I'm in cycle now and had a really bad couple of days. I just started the melatonin, and verapamil, and I understand that I may need one to two months for it to make any difference. Thank God for the Imitrex. Also, I've been trying Red Bull, and it seems to work 50% of the time.
Well, I'm kind of dealing with a heavy "shadow" after a 2 in the morning attack, and I know I'm gonna get hit more today. Wish me luck.
. . . and thanks again.
Deb : 
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