jfrillin Posted April 28, 2020 Share Posted April 28, 2020 HI. I understand there has been serious effort put forth to get insurance companies to list Oxygen as a medical necessity for CH sufferers and to get them to cover it under their insurance plan. My husband is coming up to his cycle. I just called our health insurance company and Oxygen is still NOT covered. Is subject to our deductible. What is the latest information regarding insurance companies regarding Oxygen?? 1 Quote Link to comment Share on other sites More sharing options...
IslandStorm Posted May 1, 2020 Share Posted May 1, 2020 Appeal the denial by calling the insurance co. and request a doctor to appeal on your behalf. Sending the peer reviewed O2 effectiveness studies ( links found by searching for O2 on this site) for your doctor to refer to when appealing the denial will be helpful. This process of persistence took weeks with successful results and Apria finally delivered O2 to my home to be able to battle my upcoming episode. 3 Quote Link to comment Share on other sites More sharing options...
jon019 Posted May 1, 2020 Share Posted May 1, 2020 (edited) ...absolutely the above....denying O2 prescribed by your physician is practicing w/o a license.....tell 'em you know they are doing that...get your Doc (hopefully a headache specialist) good and pissed and writing a letter on your behalf (same for triptans BTW)...involve your company HR if you are working, and the insurance broker who sold the policy....they have more pull than you...be professional but persistent from these multiple angles. went thru this at least 7 times with ins companies...always got what I needed in the end.....they COUNT on folks giving up...don't be one of those..... edited to add: worth asking your physician to include the word "intractable" in the cluster headache diagnosis discussion...according to one broker...this is a key word. also important that the correct diagnosis codes included in any communication with insurance....am hoping someone can post these as I cannot find at the moment.... Edited May 1, 2020 by jon019 2 Quote Link to comment Share on other sites More sharing options...
CHfather Posted May 1, 2020 Share Posted May 1, 2020 3 hours ago, IslandStorm said: Sending the peer reviewed O2 effectiveness studies ( links found by searching for O2 on this site) for your doctor to refer to when appealing the denial will be helpful. https://jamanetwork.com/journals/jama/fullarticle/185035 Note that O2 is also listed as a #1 treatment for CH in every article or physician's guide to CH treatment (along with triptan injections and nasal sprays). 3 Quote Link to comment Share on other sites More sharing options...
Sbr Posted January 29 Share Posted January 29 Looking for any current update regarding Medicare coverage of O2 for clusters…not finding on CMS site…. Quote Link to comment Share on other sites More sharing options...
CHfather Posted January 29 Share Posted January 29 @Sbr, as far as I know, national Medicare has made O2 coverage optional for the regional Medicare offices. I don't know of a more recent policy statement (but maybe there is one). It has been my understanding that practically all of those regional offices are authorizing coverage. The legal language says, "[C]overage determinations will be made by the Medicare Administrative Contractors under section 1862(a)(1)(A) of the Social Security Act, as allowed and described in Chapter 1, Section 240.2 (Home Use of Oxygen), Subsection D, of Publication 100-03 of the NCD Manual." The Medicare Administrative Contractors [MACs] are listed here -- https://www.cms.gov/medicare/coding-billing/medicare-administrative-contractors-macs/who-are-macs -- and I suppose it might be feasible to call yours and ask. 1 Quote Link to comment Share on other sites More sharing options...
Dallas Denny Posted January 29 Share Posted January 29 @spinyhas been successful getting MC coverage for O2 I believe?? The original approval was at least a year ago so you'd think it would be common knowledge regionally by now??? 2 Quote Link to comment Share on other sites More sharing options...
eagleswings Posted January 29 Share Posted January 29 10 hours ago, Sbr said: Looking for any current update regarding Medicare coverage of O2 for clusters…not finding on CMS site…. I'm in Indiana (near Louisville, KY) and I have my O2 approved by my Medicare plan. My O2 company refused to run it at first, I told them to humor me and they called within 24 hours saying it was covered (they were shocked...I was not). Anyway different regions can be different, ALSO make sure the O2 company runs it- ask them to show the denial 2 Quote Link to comment Share on other sites More sharing options...
spiny Posted January 30 Share Posted January 30 I'm in NC and it was covered last year. Lincare is the provider here and several offices knew of it when I called just to see how far the 'word' had traveled last year. 3 Quote Link to comment Share on other sites More sharing options...
Celtic Cluster Posted March 12 Share Posted March 12 Hey Spiny, I’m in NC too! In Charlotte. Where area are you located in?! I get a prescription for my O2 but I don’t think it goes through the insurnace and have to pay $15 a bottle. Side note: I’ve been suffering for 15 years and I’m currently 2 rough months into this period with 4-5 headaches a night every 1.5hrs after going to sleep and one when I get up. Interesting and tough cycle this one! 1 Quote Link to comment Share on other sites More sharing options...
jon019 Posted March 12 Share Posted March 12 10 minutes ago, Celtic Cluster said: I get a prescription for my O2 but I don’t think it goes through the insurnace and have to pay $15 a bottle ...might not make any difference....when i self paid it was $14/e-tank....when insurance covered it was a $14 co-pay. they got us coming and going... 3 Quote Link to comment Share on other sites More sharing options...
Amholla3 Posted March 12 Share Posted March 12 I'm in the Raleigh/Durham area in NC! Hi neighbor(s)! 2 Quote Link to comment Share on other sites More sharing options...
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