Medicare coverage of 02

[Pedestrian]

Does anyone know if there has been any progress in getting Medicare to cover oxygen for cluster headaches? United Healthcare continues to give me the runaround and ambiguous information. Thanks

[CHfather]

Some of us were just looking into this.  I have reached out to some people who might know, but still don't have a solid answer.  I'm told that this is the new document: https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=343&ncdver=2.  I have a hard time making sense of it, and my conclusion, maybe completely wrong, is that it says that O2 is no longer disapproved, but there is not new guidance, and so (in the part in red) "In the absence of an NCD [national coverage determination], coverage 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."  This is all mind-busting to me -- and I might be understanding it all wrong.

[Pedestrian]

Sounds like they want you to be enrolled in a clinical trial? Of course they don’t mention how that occurs.

[CHfather]

I think that's a separate thing . . . but don't really know.  I am not terrible at reading regs, and other people who are not terrible at reading regs have also looked at it, but we're not able to confidently conclude what it says.  Still waiting on one or two folks who might have a definitive answer.

[Pebblesthecorgi]

It means Medicare does not disapprove coverage. It also means O2 is an acceptable option to treat clusters from an agency standpoint.  Secondary insurers and primary insurers generally follow medicare guidelines but are not obliged to.  Remember all of these insurance companies act like little franchises under one big umbrella.  Depending on the employer they are representing, risk group insured are in and state regulations coverage can vary even within what seems like the same organization.  It is confusing and totally sucks they can do this.  If you are getting pushback you need to keep appealing to the benefits manager at your HR department or case worker until satisfaction is obtained.  At this point, based on the medicare ruling, the insurance company is choosing not to cover.  Have them do a cost analysis of oxygen verses CGRP drugs or triptans..The way is paved but the fight persists.

[Juss]

Assuming CMS will cover oxygen, you will not have enough tanks to abort. My recommendation is industrial oxygen. It is my impression that an industrial HVAC supply house will allow you to purchase such tanks if honest and if you explain. You are not purchasing anything that requires an EPA 608 Universal Refrigerant License. And as stated, I have offered my business accounts numerous times, which should be active. I assume that everyone wants to see my inactive licenses?

I was heavily involved with the RE Michael Executives 17 years ago, look that supplier up. Their executives formed a company and I was the lead HVAC Mechanic. From there, I became an Oil Heat Mechanic, Controls Engineer, and Refrigeration Mechanic and should have an account with Penco and United Refrigeration. I knew a few of the sales executives at Penco, dated one of their daughters, one was a close friend of the family. That account should be active. 

Yeah, before screwing my life to hell and back was deeply connected to politics and executives. Oh well. Such is life. In my world, it is called blacklisted, even family. 

 

[Juss]

If you want, and seriously, do you want to get clarification from representative S? I have a private email and he knows my family. I suppose that this is justifiable for pulling the phone a favor card. 

[CHfather]

28 minutes ago, Juss said:

Assuming CMS will cover oxygen, you will not have enough tanks to abort.

I'm not sure why this would be so.  Does Medicare limit the number/size of tanks? Once there is coverage, I would assume (maybe wrongly) that a medical O2 supplier would provide what is needed, perhaps with the same hassles that others experience because CH is not generally understood by O2 providers, but not because of the nature of the coverage.

31 minutes ago, Juss said:

My recommendation is industrial oxygen. It is my impression that an industrial HVAC supply house will allow you to purchase such tanks if honest and if you explain.

I don't know whether you are referring here to the places where industrial/welding O2 is typically purchased by people with CH, but at those places, if you are honest and explain that this is for CH, they will send you away empty-handed (except maybe in some very rare circumstances), because they are prohibited from selling O2 for medical purposes. https://clusterbusters.org/forums/topic/5627-notes-about-welding-o2/  Industrial/welding O2 can be a great thing, but it has some disadvantages in relationship to medical O2, one of which is the hassle of having to return the tanks yourself to get "refills," rather than having them brought to your door.  And medical O2 with insurance might be less costly than welding O2, depending on a lot of factors. 

1 hour ago, Juss said:

I have offered my business accounts numerous times,

This is a generous offer. For the sake of clarity, though, no license or other document is required to walk into a place that sells welding O2 and buy it (at least I have never heard of a person having that issue).

[Juss]

I was referring to HVAC or Refrigeration supply houses. They sell by, jeese, I forget the size but it can be a massive tank. And most of those places will require you to be a licensed contractor for you to purchase any supplies or tanks. That is why I offered my accounts. I can talk to my representative, well which one, lol. Here is evidence. I put my money where my mouth is. 

https://photos.app.goo.gl/PaQhAbfgZ4BqrADm9

[CHfather]

I was only suggesting that your offers are very thoughtful, but it need not be too complicated.  You walk into a welding supply store, get a tank by telling a fib about why you want it -- if anyone asks, which is highly unlikely -- and walk out.  A "massive" tank is good, but very hard for most of us to transport.