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Title: New Oxygen Trap? Post by Dave_W on May 7th, 2004, 9:30pm OK, so last night I get a call from a respiratory therapist. I get my oxygen paid for in full by Blue Cross, and there's a new Medicare rule that BCBS has adopted. Everybody who regularly gets oxygen therapy has to have its efficacy evaluated. I must sleep one night with oxygen (and a blood oxygen monitor) and one night without oxygen (and a blood oxygen monitor). They have to document that oxygen does, indeed, provide me a benefit or else they'll stop paying for it. Looks like I'm in for another battle. Wish me luck, team!! Old Weary Dave |
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Title: Re: New Oxygen Trap? Post by Magman on May 7th, 2004, 10:32pm You can thank the new Prescription card rules/systems for this. And in approx. 19 months....it will all change again. |
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Title: Re: New Oxygen Trap? Post by firebrix on May 7th, 2004, 10:42pm Sure do wish you luck Dave_W!! That does seem to be a cruel requirement from the insurance company!! Down here, we hire the tanks and pay to have them filled - this saved a lot of aggravation, but maybe O2 and tanks are more expensive where you live? Hope you sort this out soon and that your nights are peaceful. firebrix |
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Title: Re: New Oxygen Trap? Post by mynm156 on May 8th, 2004, 12:18pm Yes my friends as a Respiratory Therapist and fellow CH the primary reason that Oxygen is used is for cellular respiration so yes that is how Medicare and the Insurance companies think. Yes you are in for some what I like to call STUPIDIDTY headaches but a letter from your Doctor detailing this is needed for a different purpose other than your Oxygen Saturation or what they will call SpO2. Get on this now before you get behind thier buricratic BS and get denied. Good Luck and let me know if there is anything that I might be able to help with! Rock on PAIN FREE baby |
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Title: Re: New Oxygen Trap? Post by Dave_W on May 8th, 2004, 8:53pm Thanks Team, for the support. I think I got the right lady on the phone finally. She said she'd write the diagnosis in big letters on the form and send it in, with "not applicable" for the result. Apparently they have a code for cluster headache now that's listed separately under migraine variants, so that oxygen is an acceptable therapy. Old Hopeful Dave |
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Title: Re: New Oxygen Trap? Post by Magman on May 9th, 2004, 9:47am on 05/08/04 at 12:18:26, mynm156 wrote:
Mynm: Thanks for the insight and info on 'how' to handle this issue. Only one problem though.....since our illustrious officials, both governmental and insurance, see fit to force verification, it only imposes more hassle and expense for all. Case in point.....a letter from my Neuro for a legal proceeding costs $60.00 [pre-paid] and requires an office visit prior to drafting of such a letter....another $20.00 copay. Forms, as provided by insurance companies, legal or government entities cost $45.00 each when prepared by the doctor. If a patient has recently switched doctors [I recently fired my old Neuro], multiple charges/visits could be required to cover a particular time-frame, since one doctor will not respond to conditions prior to their initial consult/visit. Because my previous Neuro diagnosed Migraines for 9+ years, he would not respond with information concerning CH….so I lose 9 years worth of verification for CH…..not to mention 12+ years worth of history while residing in another region of the country….again all previous diagnosis were for Migraines. The ‘STUPIDITY’ headaches we are forced to deal with are just that! Ridiculous requirements imposed by government for treatments already in place is nothing more than the ‘system’ sticking their hands in our pockets and raping us once again. Pardon the rant…..just one sufferer who has had it with this so-called fair and equitable system we refer to as ‘our chosen leaders’! Peace, -dan |
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