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        New Message Board Archives >> 2007 General Board Posts >> Stupid Insurance Company
        
(Message started by: Lizzie2 on Nov 15^th, 2007, 3:45pm)

Title: Stupid Insurance Company
Post by Lizzie2 on Nov 15^th, 2007, 3:45pm

They won't pay for liquid oxygen because of "the diagnosis." WTF?! CH'ers probably go through more oxygen in a month than people with lots of other diagnoses that they would pay for it for.

I hope they pay for it when I return my tanks every 5 days to be refilled because they run continuously dry.

Sometimes I hate our fucking medical system.

Sorry to rant - I'm just pissed off that every time I get excited about something, it turns to shit.

:(

Title: Re: Stupid Insurance Company
Post by LeLimey on Nov 15^th, 2007, 4:03pm

Carrie can I help in any way? By providing info my my useage and supply for instance? I know I'm not in the same country but if the onfo will help I'll be glad to oblige!
Helen

Title: Re: Stupid Insurance Company
Post by Lizzie2 on Nov 15^th, 2007, 4:12pm

Maybe you can...

Here's what happened. Today I had my neuro NP appt, and I asked her about this. She said she didn't know how to write the script, so she would call the oxygen supply place and figure out what to do, and then call me later. She called me this afternoon to say that the woman she spoke to said the insurance wouldn't cover it for CH, but apparently it wasn't the same woman I spoke to, who said that if I had a prescription, then they would just need to get it authorized.

So then the neuro NP told me not to give up, so I called the home O2 supplier myself trying to talk to the same woman I spoke with the other day. Apparently she isn't in the office, so I spoke with the same person that Rachel (NP) spoke to. Once I explained that I'd used it in England and the reason why it is covered there, she said she would look into it and call me back.

About a half hour ago, she called me back to say that she called the insurance company and they won't cover it for a diagnosis of cluster headache. I said that's a real shame because of the amount I use it and lack of portability of the tanks, which only last through a short amount of time anyway. She said, "Well we have smaller tanks." What good would that do really? Maybe for 1 hit or so...but right now, I'm getting 4-6 and sometimes more every day, so I'm going through it pretty fast. Sure I could lug it around, but I'd need to throw like 10 of them in my car to do me much good.

I just told my dad (in tears...I'm tired of having nothing ever work out), and he said that maybe I should call another supplier - but I explained to him that it's my insurance company that said no, so that wouldn't matter. He suggested maybe I call the insurance company myself. But I want to look into what I would have to do and say more before I call them, which is maybe how you could help.

Also, I don't know how much good it will do me if I'm calling them when I don't even have a prescription or anything to appeal.

I'm lucky I have oxygen at all - I'm just worn out from the pain lately and tired of fighting for every single inch. Know what I mean? So anyway...

Thanks for the offer - maybe you can direct me in what I should say/do with the insurance...

Hugz,
Carrie

Title: Re: Stupid Insurance Company
Post by Melissa on Nov 15^th, 2007, 4:22pm

So basically you're not getting the liquid O2 because you want your insurance to pay for it, is that right?

Well, how much more expensive would it be to pay for it out of pocket than the amount of O2 tanks you're going through?

Title: Re: Stupid Insurance Company
Post by Lizzie2 on Nov 15^th, 2007, 4:41pm

on 11/15/07 at 16:22:33, Melissa wrote:

Right I want them to pay for it. I couldn't use oxygen at all if they didn't pay for it. I pay nothing for the O2 right now - they pay for it entirely - it's just the driving 45 minutes to get the tanks filled from the only O2 supplier they let me use that is expensive for me!

I know that my home O2 was costing $400/month without insurance during the 2 months I was on Aetna HMO when I was in nursing school, but I don't know how much the liquid O2 costs. I know it is more expensive than the traditional tanks, and since I couldn't even afford to have the traditional tanks when they weren't covered before, I definitely cannot afford to pay for the LOX out of pocket.

I get by fine - other than the having to frequently replace the tanks and not being able to really cart them everywhere I go easily. But I'll live. I will fight it with the insurance company though, if there is a way.

Title: Re: Stupid Insurance Company
Post by fubar on Nov 15^th, 2007, 5:19pm

$400 per month? WTF were you using?

Those oxygen machines are shit, they only produce 7 or 8 lpm, and the purity is only about 85% O2. Oxygen tanks, on the other hand, give you pure, high-flow O2, and they are CHEAP CHEAP CHEAP. If you had to fill 40 of them in a month, it shouldn't cost more than $100, seriously. That stupid O2 machine rental is a SCAM by the O2 provider... the machine costs maybe $2000, but they let it sit at your house and earn $400 a month. My O2 provider wouldn't let me have the tanks unless I accepted the machine as well (so they could bill the insurance company $400/month forever). So, basically, I left the machine in the closet so they could bilk my insurance for $400 a month... they would give me as many O2 tanks as I wanted as long as I played ball and let them scam my insurance company for the O2 machine rental. It's a SCAM.

If you could just get welders O2 and a regulator to fit it, the total cost out of pocket per month might be $5. Forget the insurance company. I do this now, and I don' have to deal with any shit from the O2 provider or the insurance company, AND it's cheap as hell.

-Fu

Title: Re: Stupid Insurance Company
Post by Kevin_M on Nov 15^th, 2007, 6:13pm

Lizzie,

Here is an article about LOX and mentions its application for clusters. Maybe if presented to your neuro, she will go to bat for you, as an option. But I have noticed the link says UK at the end.

The application in question is for a new cryogenic liquid oxygen product (LOX).

2.2 USE This product can be used in the treatment or prevention of acute or chronic hypoxia; as part of the fresh gas supply in anaesthesia or intensive care; as the propellant gas in nebuliser therapy; and in the treatment of acute attack in patients with an established diagnosis of cluster headache.

Try one of this link, I have trouble with pdf files. Or google - cluster headaches, liquid oxygen, lox

www.mhra.gov.uk/home/idcplg?IdcService=GET_FILE&dID=27906&noSaveAs=0&Rendition=WEB

here is the google search, it's the first item on the google page.

http://www.google.com/search?hl=en&ie=ISO-8859-1&q=cluster+headaches%2C+liquid+oxygen%2C+lox&btnG=Search

Title: Re: Stupid Insurance Company
Post by Donna_D. on Nov 15^th, 2007, 7:07pm

Carrie,

What is the name of your insurance carrier and which state guidelines are they following? Also, is your doc willing to sign a letter of medical necessity? Will the overall cost be less if you switch to LOX and can you document your Current usage v. Projected LOX usage?

Let me know the answers and I will see what I can do to help.

DD

Title: Re: Stupid Insurance Company
Post by Kevin_M on Nov 15^th, 2007, 7:32pm

on 11/15/07 at 19:07:02, Donna_D. wrote:

is your doc willing to sign a letter of medical necessity? Will the overall cost be less if you switch to LOX and can you document your Current usage v. Projected LOX usage?

Past usage could be documented by either the delivery receipts or by calling the supply company for last six months deliveries, her cost seems to be $400.00 a month. Online at Aetna I can get my insurance company's cost ($34.00 a month), that might be possible for you too, Carrie.
Inquiring of the personal cost for LOX may be possible with the supply company, not sure about the negotiated cost to insurance company.

Title: Re: Stupid Insurance Company
Post by Lizzie2 on Nov 15^th, 2007, 7:39pm

Thanks for the responses!

Fu - are you talking about a concentrator? Cuz I can see what you mean about those, but I have used liquid oxygen (LOX) at 15LPM (right Helen?) and it worked way better for me, which I said in the other post when I thought I was going to get it. And I'm serious - what I had at the time was an H tank and a regulator, and it cost $400/month. Crazy, isn't it? I don't pay any copays for DME, so I don't pay for my home o2 use now - and I have had some help with regulators/bubblers from people here that have allowed me to actually use the bubbler with it.

Kev - Thanks, that is helpful. I was thinking of trying to find the criteria that the NHS uses for determining who qualifies for LOX over there, so that I could show it to the company.

Donna - Blue Cross Personal Choice in Philadelphia, PA - so they're going by PA state regs. My doc would definitely be willing to sign a letter of medical necessity. The NP told me to contact her if I need more help with it, and she'll be glad to help - the fact that she called me at home and talked to me for a few minutes was a big deal - not many go the extra mile anymore! Mine do, however. I'm not exactly sure what price the insurance companies pay every time I fill the tanks, but that would be something I should find out in determining if LOX costs less overall. I was just thinking in the car that I need to prove how they can save money. I can definitely map out usage - unfortunately because I didn't use my O2 for quite some time before this (due to heavy reliance on amerge and frova, which worked), I don't have good evidence yet of having forced them to pay for frequently refreshed tanks, but I will now as this is pretty much the only thing working for me! Helen's LOX page discusses how long the tanks last, so I could calculate out projected usage of LOX if that would be helpful. I appreciate your offer to help me!

Thanks for all the suggestions and offers to help - it is very much appreciated!! I realize I can continue on with what I have, but I think the LOX would make my life much easier and improve many things, including abort time for the hit, although I can't take that to the O2 or insurance company since they probably wouldn't believe it if I told them! Either way.......onwards and upwards I guess!

Hugz,
Carrie :)

Title: Re: Stupid Insurance Company
Post by Lizzie2 on Nov 15^th, 2007, 7:44pm

on 11/15/07 at 19:32:10, Kevin_M wrote:

For your first point, I answered it in my 1st response in that I wasn't using O2 for a long time, but I can document it from here on out since I am using it a LOT now. I just signed up for ibx.com online and can get my claims, so I will check into how much they are paying monthly for the O2. My $400/month was what I was paying with Heron Home Health, and now I'm using Jefferson's home health, so it may be different. I'm thinking since you get more bang for the buck with the LOX, that I wouldn't have to have the tank refilled so much and it might be cheaper - especially if it works quicker and I use less oxygen than I would with the tanks.

My dad asked me how much it would cost for the LOX out of pocket, and I don't know the answer to that. I tried to find out some estimates online but wasn't successful in really learning much, other than how highly recommended it is for ambulatory patients! haha In my quest for proving that I need this, I may call the O2 supplier back to find out personal out of pocket expense without insurance coverage, but I don't know that I'd actually be able to afford it - especially if it runs anywhere close to or above $100/month.... $100/month would be a strain, but I might be able to work it out - especially if I work a little overtime each pay period. I just have this feeling it's more than that!

Title: Re: Stupid Insurance Company
Post by LeLimey on Nov 16^th, 2007, 3:09am

Carrie it is 15LPM that you were using here.
If you want me to write out how much better it made life for me and how much less O2 I'm able to use aborting in this way I will do so (I can abort quicker now)
A testimonial from another user may help!
Also, I have pics of the whole system on my webshots
http://community.webshots.com/user/lelimey

You can copy them all you like or direct them to it if it will help. I don't mind either way.

We'll get you LOX - humph!

Helen

Title: Re: Stupid Insurance Company
Post by cash5542 on Nov 16^th, 2007, 11:50am

Carrie,
I had so much problems in the beginning when Lisa was in Lancaster. I am still trying to get reimbursed for the $200 I paid that MD Blue Cross said I shouldn't have paid. Once MD Blue Cross got involoved she got all she needed, coverd 100%, delivered to the house she lived at. I don't know why Pennsylvania is so hard to work with. Just keep at it. They wouldnt cover it at first either when it was put through Penn. Blue Cross (and this wasn't even for liquid!)

Charlotte

Title: Re: Stupid Insurance Company
Post by Lizzie2 on Nov 16^th, 2007, 8:29pm

Helen - if you would write something, I think that would potentially be very helpful. Also, do you know if the NHS's policy on LOX for CH (who gets it versus who doesn't) is in writing anywhere? I even told the neuro NP (saw her in the hall at work today) about looking for something published by the NHS - some criteria on LOX, and she thought that was a good idea. She is, indeed, more than willing to write a letter of medical necessity for me or do any other thing I need done. Thanks also for the links to the photos! :-*

Charlotte - Does Lisa use liquid O2 or the regular tanks? I agree that PA is hard to work with! Don't know why exactly!! My goal is to prove how this will save them money... I don't have a lot of energy to do it right now - was hit 4 times today at work alone, and I still have to work 12 hours tomorrow and Sunday, but I plan to continue to fight this.... Hugz!!