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Medicare advantage plan denied me payments

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nebrhahe53

Very helpful member
Joined
Jun 13, 2014
Messages
1,016
Reason
PALS
Diagnosis
06/2014
Country
US
State
Tx
So I was just denied payments for nutritional supplements even though I have a feeding tube and a diagnosis of ALS because the supplements are not medically necessary.
I was also denied a breathing mask for my Bipap and headgear because of the same reason. How can you use the BiPAP without headgear?
 

gooseberry

Extremely helpful member
Joined
Jul 2, 2014
Messages
3,457
Reason
Lost a loved one
Country
US
State
FL
Can you appeal the decision? If so, I would ask those very questions. Aetna has told me a nurse or claim person does the inital assesssment of if something is medically necessary but a specialist familiar with the area would review the appeal.
 

SMP51

Senior member
Joined
Oct 31, 2011
Messages
675
Reason
CALS
Diagnosis
11/2010
Country
US
State
FL
things have to be worded precisely. if the head gear is an added expense to the BiPAP then an explanation to why it is needed for your well being has to be spelled out... stupid, I know! Tell the med supply company you are not paying for it and they need to resubmit to Medicare if they want their money.
When we got Steve's Remote control wheel chair the doctor and the physical therapist had to methodically list all the features the chair had to have and why....because the patient has ALS and is a paraplegic on the decline in health is somehow not self explanatory and would be denied!
13 pages of details from both the doc and therapist and we got clearance for a chair
 
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