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        New Message Board Archives >> 2006 General Board Posts >> Little Advice
        
(Message started by: Neekwa on Apr 1^st, 2006, 10:05pm)

Title: Little Advice
Post by Neekwa on Apr 1^st, 2006, 10:05pm

Seems like this is my first stop lately following an attack. Just recouping now from a 45 min one. Same scenario all the way around, just glad it's over really. Today for me so far has been four total since I awoke at around 3 am. This one being the longest and most painful. An under 30 min one earlier, and two mild ones which weren't too bad actually.

Regarding the oxygen, heres what I need advice on. During a doctors appointment a few months ago I walked out of the office assured that I would be receiving a tank and breather mask which was supposed to be home delivered. The following day I received a call from my doctor informing me that in fact my insurance would not cover the tank etc.

So as expected I asked him how much for the setup out of my own pocket. He replied somewhere in the $450 range, I don't recall the exact figure but somewhere around there. He also informed me that he could attempt to persuade them and possibly swing it for me. I agreed to give that a shot.

Well weeks had passed and I received another call from him saying he wrote a request/recomondation to my insurance provider and had just received in return a request from them that I undergo various heart tests to substantiate that I need oxygen for a blood pressure condition.

My blood pressure has always been fine! So at that point (and this is what I am awaiting on now) he told me he would submit an official "appeal" to my insurance and get back to me when he gets the word on that. Well, here I am still suffering and that's been close to a month ago now!

So the advice I need is should I spend over $400 dollars here, or continue to play this waiting game with the insurance provider? As I'm sure we are all aware, we have better things to spend close to $500 bucks on. But on the other hand the outright suffering is just starting to really get on my nerves a tad, especially after four years straight of it! While on topic with this, does $450 seem a little steep for a tank and a dangly little mask or what?

Title: Re: Little Advice
Post by E-Double on Apr 1^st, 2006, 10:31pm

Have the doctor write about CH that oxygen is not needed to help you breathe!!!!!!!!

Throw in some other shyte too!!!

It is known as a FIRST LINE ABORTIVE!!!!!!!!!

http://www.chhelp.org/mhni.html

http://www.mhni.com/Summer%20Fall%202004%20Issue%2033.pdf#search='todd%20rozen%20high%20flow%20oxygen'

Many rescources from our cluster bud Mast...
http://www.maplefallswebdesign.com/misc/oxygen/oxygen2.htm

Title: Re: Little Advice
Post by Linda_Howell on Apr 1^st, 2006, 10:41pm

No. Sounds A LOT steep.

There are ways around almost everything and I have a few ideas.

Your Dr. sounds like he's willing to help you, will he give you a prescription for 02 and if he already has, take it to any 02 supplier and get yourself some E-tanks. I'll send you a non-rebreather mask and I know a curmudgeon of a guy who will sell you a regulator cheap. (No, I didn't say you were cheap RJ)

One other thing....Do you have access to a welders tank?

PM me if you need anymore info. & I'll be happy to help you.

Linda

Title: Re: Little Advice
Post by Lizzie2 on Apr 1^st, 2006, 10:42pm

Do you know if your insurance policy has a clause for Durable Medical Equipment (DME)? If yes, then appeals and continuing the fight may be worthwhile.

If you don't have DME with your insurance, then, in most cases, all the appeals in the world simply aren't going to matter. They will just say they don't cover DME.

It may be your doctor submitted that you need it for blood pressure issues because he was trying to get it for a reason your insurance company considers legit....which would almost indicate to me that you DO have a DME clause, but that it is rather restrictive and he's trying to get around it.

From the home care suppliers, it really is around $400 or so a month for an H tank and regulator to rent. But watch that because that's a monthly fee for the rental...even if you don't refill the tank very often.

Would most definitely be cheaper to get ahold of a welders O2 tank and modified regulator. Jonny and other members here can provide you with necessary information if you choose to go that route.

If you don't have a DME clause, you can give them all the literature about O2 for clusters that you want; have your doctor write 10,000 appeals; explain to them that O2 is your only abortive and it would be much cheaper for them to provide for that monthly than to pay for every ER visit you will need (theoretically) to treat CH since they wouldn't allow O2....but they won't budge most likely. (And if you're wondering where I dreamt up those tactics....I used them myself in the summer of 2004 when I fought for O2 without a DME clause and lost...ended up terminating my insurance policy altogether and going with another one).

If you can find out about your DME status, that would be helpful in knowing how to help you proceed next! If you can't find that without some searching, we could start with an easier question... what type of insurance? HMO?

If you want to skip the whole crazy hassle altogether....ask Jonny and others about the welders O2 route. That's seriously the best thing to do if you lack a DME clause. I've researched almost every possible angle on that one....it really is about your only way to go in that situation.

Best of luck!
Carrie :)

Title: Re: Little Advice
Post by E-Double on Apr 1^st, 2006, 10:46pm

Oh yeah.........

We typically seal with just some shlub in cust service......
Keep nagging to talk to one of their doctors!!!
The doctor for the company will get it for ya.
I have excellent insurance and at first they would not cover it until I made them get a doctor to speak with from their office.

It was approved immediately!

Good luck and there is always a way!

Ex2

Title: Re: Little Advice
Post by Melissa on Apr 2^nd, 2006, 6:03am

We looked at what Walgreens charged for renting my O2 tanks.... $365.00 PER TANK! :o Good thing our insurance covered it, or we woulda been buying a welding tank right quick. ;)

If I was chronic, I'd definately buy my own.

Anyway, which insurance company are you through?

Maybe someone on here has the same one and could help.

:)mel

Title: Re: Little Advice
Post by Jonny on Apr 2^nd, 2006, 6:11am

Buy a 60 cubic foot welding 02 tank ($175 new) and convert a medical regulator (Cheap on Ebay)

Refills are about $15

Edit to add:....You want a Non-rebreather mask....that is KEY!!!!

Title: Re: Little Advice
Post by Neekwa on Apr 2^nd, 2006, 12:54pm

Just got back to the box, and this is some great info.

Quote:

Do you know if your insurance policy has a clause for Durable Medical Equipment (DME)? If yes, then appeals and continuing the fight may be worthwhile.

See this is something I have no idea about. I'm going to call my physician today to find out (and most likely may have to schedule yet another appointment). But this is the first thing I'm going to bring up.

Quote:

It may be your doctor submitted that you need it for blood pressure issues because he was trying to get it for a reason your insurance company considers legit....

This sounds about right to me also, and makes a lot of sense concerning this postponed run around. He wrote out a prescription for o2 I'm thinking and was gambling that it would just be approved. Obviously he can't prove I indeed have a blood pressure issue so his next alternative being the appeal route. Currently I'm under (OHP) state health insurance.

I don't have access to a welders tank but I'm sure I could pin one down somewhere, then proceed to convert it to fit my needs if in fact I get dead ended with the appeals. First things first, I'm going to contact my physician today and run over a lot of this with him. As soon as I find out I will definitely report back the situation. Thanks to everyone for taking the time to point out these things, and give me the low down

Title: Re: Little Advice
Post by Neekwa on Apr 2^nd, 2006, 1:04pm

umm...just one slight problem that I overlooked here.

- i'ts Sunday!!!! :(

Title: Re: Little Advice
Post by Sandy_C on Apr 2^nd, 2006, 1:49pm

on 04/02/06 at 06:11:58, Jonny wrote:

Buy a 60 cubic foot welding 02 tank ($175 new) and convert a medical regulator (Cheap on Ebay)

Refills are about $15

Edit to add:....You want a Non-rebreather mask....that is KEY!!!!

Question -

I am also getting a welder's tank because insurance won't pay. Not a problem finding the tank, already have the clustermasx and RJ's regulator, but where do you take the tank to get refills?

Thanks

Sandy

Title: Re: Little Advice
Post by Cerberus on Apr 2^nd, 2006, 1:58pm

Depending on your insurance provider getting O2 shouldn't be a problem, with the docs recommendation.

Here's the rub...
The letter he/she writes to your insurance company has to clearly state what it is specifically prescribed for. The blood pressure thing wont fly.
Have your doc. re-write the letter as CH specific and that the purpose of the O2 is to abort the onset of attacks. Again the "First line abortive" thing is correct.

Yes it is worth it if the insurance Co. ends up accepting... keep on em about it. Between you and the doc there should be plenty of ammo to support your case.

In the meantime...look into the welders O2 thing (make sure they don't know its not for welding) Take linda up on her offer, and in a pinch I reckon the local Fire Dept. may be able to help... I would recommend going to THEM to avoid any 911 conflicts and incurring more financial trauma than may be indicated otherwise.

Hang -in... things tend to work out round these parts.

'Bus