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Topic: Old O2 Topic & Insurance (Read 760 times) |
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Camerooskis_Mom
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Old O2 Topic & Insurance
« on: May 31st, 2003, 8:13am » |
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I'm having the Insurance battle over the O2 RX. It seems they would rather I take 7yo to emergency room at each onset to get O2 therapy than keeping it at home. HUH? Isn't this called Abortive therapy??
I've seen other posts regarding the insurance battles so I apologize for bringing up this issue yet again. I've provided the Letter of Medical Nec., the Clinicals and appealed to their sense of compassion -- afterall, a 7 year old cannot take Imitrex or any of the other meds that might help. Anybody have any ideas how I might reason them on to the side of common sense??
Thanks.
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Frank
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Re: Old O2 Topic & Insurance
« Reply #2 on: May 31st, 2003, 3:43pm » |
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Most insurance companies will only pay for oxygen if your blood oxymeter test shows that your blood oxygen level is 89% or lower. This is because they wrongly assume O2 is being prescribed for some heart or lung condition.
Your doctor needs to make it clear to the insurance company that O2 is being prescribed for cluster headaches... AND submit copies of two peer reviewed medical journal articles (or at least quote them) stating that O2 is considered by knowledgable medical professionals to be a first-line effective treatment for cluster headache pain.
That should work for most insurance companies.
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Camerooskis_Mom
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Re: Old O2 Topic & Insurance
« Reply #3 on: May 31st, 2003, 9:22pm » |
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Thank you!
I knew it was an old topic, just unsure how to get there!
{{{hugs}}} & {{{kisses}}} for a painfree tomorrow as my little one is having one tonite 
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Not4Hire
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...WAS PF since Oct.'02, but ...oh my...(CBusters)
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Re: Old O2 Topic & Insurance
« Reply #4 on: Jun 1st, 2003, 12:35am » |
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Dear Camerooskies' Mom: I am really sorry that your son has this terrible condition and I sincerely hope that you can find something that works for the little guy.
As far as waiting for *Fookin Insurance* to pay for oxygen:
DON'T WAIT!....... many doctors are reluctant to prescribe o2 because of the hassles/liabilities involved.... tell yer doc that you will pay *out-of-pocket* for o2 if they will prescribe it.... then DO THAT..... it's not very expensive to purchase a *rig*... including tank, regulator, NON-rebreather mask, etc.
...and I am confident that it will help.... it helps 70-80% of us... don't jump over a dollar to pick up a dime.... just because INSURANCE won't pay for it doesn't mean that you should NOT use it..... if MY kid needed something that would give him relief, I would sell my freakin HOUSE... I'm sure you are the same.....
...please email/IM me if you have any questions... and I hope you've seen this:
http://www.maplefallswebdesign.com/misc/oxygen/oxygen.htm
best wishes....Steve(N4H)
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Mantra: This will NOT kill me...This will not KILL me... This will not kill ME...
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Camerooskis_Mom
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Re: Old O2 Topic & Insurance
« Reply #5 on: Jun 4th, 2003, 11:14am » |
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Thanks Mark.
I've had to O2 in my home for 4 months now. Was initially told, not to worry, insurance will pay. Started getting the denials last month and presented w/ 4 months of billing due on receipt.
O2 company says insurance never pays for CH. I think I am working w/ the wrong O2 company but need to get insurance to pay for past couple months while I shop around.
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Camerooskis_Mom
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Re: Old O2 Topic & Insurance
« Reply #6 on: Jun 4th, 2003, 11:36am » |
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I'm sorry Steve...trying to multitask. Please forgive me 
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jdownes
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Re: Old O2 Topic & Insurance
« Reply #7 on: Jun 5th, 2003, 6:54am » |
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Coventry covers 80% for me. I hit a $200 cap early this year, and my neurologist wrote a letter and followed up verbally with them to explain the treatment, and they waived the cap.
Additionally, they cover only 9 pills per month for Imitrex(migraine type dosage), but they will cover 3 different RXs of 25,50, and 100 mg, so I can break up pills to survive the month. Conventry representative was actually the one who told me to do that so I would have coverage.
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