Humana Medicar Advantage plan rejecting my claims

[nebrhahe53]

I was just denied headgear and breathing mask for my BiPAP which Humana is paying for because they are "not medically necessary" Can anyone tell me how to use that machine without the tubing and mask?
They are also denying as not medically necessary my nutritional supplements I use through the feding tube. Really with a diagnosis of ALS thats not medically necessary?

 

[krnNdug]

I just had to move back to Humana since my PPO isn't on my current plan...good to know what battle I may face down the road...maybe because it is equipment that needs to be replaced more often?

 

[lgelb]

Some plans consider the headgear/masks consumables and may not cover them. Others may only cover new ones every three or six months.
The supplements are likely reimbursable. Download the pertinent document for both categories your plan from Humana and make sure the denial is not just a matter of improper coding or the traditional "if at first, deny."
If the denial is real based on the policy, scout around for discount codes/sales on the cpap sites (several are running holiday sales right now) and also medical supply sites where you order formula, are having "15% off everything" sales through at least tomorrow.

 

[gooseberry]

My husband gets a new mask and headgear every 6 months and new cushions monthly. The tubing for the trilogy is replaced monthly. Mine for the cpap has to be washed and disinfected weekly. It is replaced every 3 months. So, depending on the exact machine you have, your replacement schedule will be different.

About the nutrition supplements...they may only cover certain brands. I would ask if it is a brand dependant issue or if it is just not covered. Walmart online will let you purchase and ship for free most things like this.....so will amazon.

 

[nebrhahe53]

I think they are just denying so as not to pay. Only an idiot would pay for the machine itself and then say the tubing is not medically necessary. What am I supposed to do, wrap my mouth over the exit port of the machine?

 

[nebrhahe53]

Problem is that in this country companies can only benefit from this behavior. There is no penalty they pay for trying to mess with you, only benefits for them. Long live American medicine

 

[bigmark1954]

Problem is that in this country companies can only benefit from this behavior. There is no penalty they pay for trying to mess with you, only benefits for them. Long live American medicine

I agree completely with Neil's statement......there are to dam many restrictions and guidelines in health care and the medical profession in general.
I just went through a battle with Regence Blue Cross, over a Bipap....they said I didn't need it. My Doc had to appeal it twice, and actually had to fight with them to get me the dam machine. Private companies are as bad as government health care coverage. THEY SUCK:evil:

 

[nebrhahe53]

I think private companies are even worse than government. At least with government you have some chance of throwing out the politicians, with private companies its just greed,greed,greed

 

[gooseberry]

If you have online access with your plan, there should be an area where you can view all the plan documents and exclusions. I would look for that. Also look for your prescription formulary lißt. It may tell you if other nutritional supplements are covered that will work for you.