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jfrillin

Insurance coverage for Oxygen

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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??

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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.

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Posted (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 by jon019
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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).

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