DME co-insurance payments

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Dawood

Member
Joined
Jan 30, 2013
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26
Reason
CALS
Country
US
State
ca
City
san jose
Is there anyone else on this forum who thinks they are being overcharged for the so-called "20%" co-insurance payments for DME? Also, is there anyone who has gone without prescribed DME or chosen not to go on a vent because of the burden of making co-insurance payments? We are currently taking steps to do something about these issues and are looking for real-world examples of how these payments affect ALS patients.
 
The insurance we are stuck with till I get medicare has a clause in it that they will not pay for physical or speech therapy if there is no liklihood of improvement, and that in some cases no medical care is acceptable if there is no liklihood of improvement translation: ALS people go home and die.
 
>The insurance we are stuck with till I get medicare has a clause in it that they will not pay for physical or speech therapy if there is no liklihood of improvement

there is something fundamentally wrong with this ...
 
Max, our son has autism and we have fought the fight over the speech issue for years. The problem is, or so we have been told, because our plan is self-funded and grandfathered my company is exempt from.most of the mandatory rules. For instance, FL requires speech services and behavior therapy be paid for if a child has an autism diagnosis. But, because we have a self funded grandfathered plan,, it is legal for my company to not offer these services. And because we have insurance and are deemed to make too much money we have to carry the full cost out of pocket

My company has now added a deductible on top of the 20% copay for dme. A lot of people this will never affect but if you have a serious illness it really hurts..
 
With Medicare if you want To go on a ventilator the cost for care is 100% out of pocket. Because having a vent. Requires 24 hour care it's not covered by Medicare. In most of Europe ALS is not considered a terminal illness because with their health care system if you want to go on a vent. home health care is covered. Damn socialized health care.
 
Oh my goodness, don't get me started. With Joe being on a vent, I usually have maxed out my out of pocket in the first couple of months of the year.

Debbie
 
Oh yes, and the DME wont be payed for either if there is no prospect for improvement
 
They even require you to get preauthorization for a peg tube and it must be medically necessary-by the timr its medically necessary its too late! And then they wont pay for the jevity unless you cant eat by mouth at all.
 
Those are the kinds of things that are so frustrating. Whomever is making the decisions, either doesnt understand the disease process or isnt using common sense.
 
I think they understand very well-its a cold blooded financial decision-in this country its not about people its about money
 
there must be sme central body where issues like this can be escalated ...
 
Yea Max, the round file cabinet
 
>Yea Max, the round file cabinet

Barbie the Warrior Cynic! Just like me on the FFDA :)
 
Folks, I'm not surprised people are having problems with getting their prescribed DME. My wife and I are pursuing an arbitration right now which, if we win, we hope to bring to the attention of state and national regulators. However, vague opinions will not help our cause. We need very specific facts. Do you have medicare or private insurance? What was your prescription, and was coverage denied? If denied, what was the reason for denial. If it was covered, how much were you charged? These are the facts we need--real-world examples--specific, detailed examples--of the roadblocks ALS patients must overcome in this country to get their prescribed DME. Without specific details, we cannot make any headway to bring about a change.
 
My husbands bipap was approved quite easily but not a battery pack. In FL , th epower goes out a lot in the summer. The approval for the battery pack has been denied because it is considered comfort care and not medically necessary. I asked how this was possible since the bipap is medically necessary for my husband to breathe and we lose power frequently.. We have private insurance through my employer. It is a self insured, grandfathered plan.
 
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