The VEST

Aspiemom · Sep 13, 2007

Wow, it took me forever tonight to figure out how to start a new thread. But I'm a newbie, so....

Vanderbilt wants me to start using the inCourage Vest from RespirTech. <img src="i/expressions/vest.gif" border="0"> I have Medicare for Primary Ins. and Blue Cross/Blue Shield for Secondary through my husband.
RespirTech said that they believe Medicare has a contract amount and usually covers 100% of the cost. But then they emailed me a form for Medicare and it states that Medicare won't pay ANYTHING until they are sure it is helping you. I wanted some kind of confirmation up front before having them ship it to me because I can't afford a co-pay on something that costly.

I would think with Medicare and a secondary that it would be covered.

Have any of you people with Vests had Medicare for primary and had it refused? Or did Medicare pay part and a secondary pick up the rest? Should I have it shipped?????? They want to ship it NOW.

The paperwork did say that Medicare's policy is that CF & Bronchiectisis patients are eligible for the Vest - and I have both the CF and Bronchiectisis. I guess I'm just a little rattled since it says they can't even submit the claim to Medicare until I'm using it and it's helping. When it's this much money I like to know up front.<img src="i/expressions/face-icon-small-frown.gif" border="0">

Aspiemom · Sep 13, 2007

Wow, it took me forever tonight to figure out how to start a new thread. But I'm a newbie, so....

Vanderbilt wants me to start using the inCourage Vest from RespirTech. <img src="i/expressions/vest.gif" border="0"> I have Medicare for Primary Ins. and Blue Cross/Blue Shield for Secondary through my husband.
RespirTech said that they believe Medicare has a contract amount and usually covers 100% of the cost. But then they emailed me a form for Medicare and it states that Medicare won't pay ANYTHING until they are sure it is helping you. I wanted some kind of confirmation up front before having them ship it to me because I can't afford a co-pay on something that costly.

I would think with Medicare and a secondary that it would be covered.

Have any of you people with Vests had Medicare for primary and had it refused? Or did Medicare pay part and a secondary pick up the rest? Should I have it shipped?????? They want to ship it NOW.

The paperwork did say that Medicare's policy is that CF & Bronchiectisis patients are eligible for the Vest - and I have both the CF and Bronchiectisis. I guess I'm just a little rattled since it says they can't even submit the claim to Medicare until I'm using it and it's helping. When it's this much money I like to know up front.<img src="i/expressions/face-icon-small-frown.gif" border="0">

Aspiemom · Sep 13, 2007

Wow, it took me forever tonight to figure out how to start a new thread. But I'm a newbie, so....

Vanderbilt wants me to start using the inCourage Vest from RespirTech. <img src="i/expressions/vest.gif" border="0"> I have Medicare for Primary Ins. and Blue Cross/Blue Shield for Secondary through my husband.
RespirTech said that they believe Medicare has a contract amount and usually covers 100% of the cost. But then they emailed me a form for Medicare and it states that Medicare won't pay ANYTHING until they are sure it is helping you. I wanted some kind of confirmation up front before having them ship it to me because I can't afford a co-pay on something that costly.

I would think with Medicare and a secondary that it would be covered.

Have any of you people with Vests had Medicare for primary and had it refused? Or did Medicare pay part and a secondary pick up the rest? Should I have it shipped?????? They want to ship it NOW.

The paperwork did say that Medicare's policy is that CF & Bronchiectisis patients are eligible for the Vest - and I have both the CF and Bronchiectisis. I guess I'm just a little rattled since it says they can't even submit the claim to Medicare until I'm using it and it's helping. When it's this much money I like to know up front.<img src="i/expressions/face-icon-small-frown.gif" border="0">

Aspiemom · Sep 13, 2007

Wow, it took me forever tonight to figure out how to start a new thread. But I'm a newbie, so....

Vanderbilt wants me to start using the inCourage Vest from RespirTech. <img src="i/expressions/vest.gif" border="0"> I have Medicare for Primary Ins. and Blue Cross/Blue Shield for Secondary through my husband.
RespirTech said that they believe Medicare has a contract amount and usually covers 100% of the cost. But then they emailed me a form for Medicare and it states that Medicare won't pay ANYTHING until they are sure it is helping you. I wanted some kind of confirmation up front before having them ship it to me because I can't afford a co-pay on something that costly.

I would think with Medicare and a secondary that it would be covered.

Have any of you people with Vests had Medicare for primary and had it refused? Or did Medicare pay part and a secondary pick up the rest? Should I have it shipped?????? They want to ship it NOW.

The paperwork did say that Medicare's policy is that CF & Bronchiectisis patients are eligible for the Vest - and I have both the CF and Bronchiectisis. I guess I'm just a little rattled since it says they can't even submit the claim to Medicare until I'm using it and it's helping. When it's this much money I like to know up front.<img src="i/expressions/face-icon-small-frown.gif" border="0">

Aspiemom · Sep 13, 2007

Wow, it took me forever tonight to figure out how to start a new thread. But I'm a newbie, so....

Vanderbilt wants me to start using the inCourage Vest from RespirTech. <img src="i/expressions/vest.gif" border="0"> I have Medicare for Primary Ins. and Blue Cross/Blue Shield for Secondary through my husband.
RespirTech said that they believe Medicare has a contract amount and usually covers 100% of the cost. But then they emailed me a form for Medicare and it states that Medicare won't pay ANYTHING until they are sure it is helping you. I wanted some kind of confirmation up front before having them ship it to me because I can't afford a co-pay on something that costly.

I would think with Medicare and a secondary that it would be covered.

Have any of you people with Vests had Medicare for primary and had it refused? Or did Medicare pay part and a secondary pick up the rest? Should I have it shipped?????? They want to ship it NOW.

The paperwork did say that Medicare's policy is that CF & Bronchiectisis patients are eligible for the Vest - and I have both the CF and Bronchiectisis. I guess I'm just a little rattled since it says they can't even submit the claim to Medicare until I'm using it and it's helping. When it's this much money I like to know up front.<img src="i/expressions/face-icon-small-frown.gif" border="0">

Alyssa · Sep 13, 2007

We own both a RespirTech & Hill-Rom vest.

Hill-Rom specifically told me to take the vest and don't worry about insurance - they do whatever it takes to keep the vest in the home. He said they may swap out the machine (take the brand new one back and replace it with a rental unit if need be, but we would keep a machine) Our rep also referenced a story about on person keeping the vest through a 6 year battle with the insurance company -- at which time they finally exhausted all appeals and lost the battle. Hill-Rom told the patient to keep the vest free of charge.

I have a suspicion the RespirTech would tell you something similar (not the same type of story maybe) but they should tell you to take the vest and not to worry about the purchase price. If push comes to shove the worst they can do is take the machine back -- I don't think they can force you to keep it and pay for it.

Just ask them about the "what ifs" I suspect they will stay "we do whatever it takes to keep the machine in the house" -- especially if you tell them that's what Hill-Rom says !

I also think that with dual insurance coverage, they will be willing to take their chances.

Another thought is .... it is very likely you will get improvement and your doctor will be willing to back that up in writing so Medicaid will pay -- all it takes if for you to say you are coughing up more sputum (and you will) and that is improvement (most doctors are very willing to help you out in any way possible to get a vest in the home)

My son just increased his FEV1 by 11% (from 74% to 85%) when he started Pulmozyme, Hyptertonic Saline and the RespirTech vest for 7 weeks.

Short story -- let them ship the vest -- use it -- feel better! I really think you have a good shot at either one of your insurance companies paying for most if not all of the vest - or at the very least one of them will agree to pay the rental fee forever -- and that would not cost you a penny.

Good luck

Alyssa · Sep 13, 2007

We own both a RespirTech & Hill-Rom vest.

Hill-Rom specifically told me to take the vest and don't worry about insurance - they do whatever it takes to keep the vest in the home. He said they may swap out the machine (take the brand new one back and replace it with a rental unit if need be, but we would keep a machine) Our rep also referenced a story about on person keeping the vest through a 6 year battle with the insurance company -- at which time they finally exhausted all appeals and lost the battle. Hill-Rom told the patient to keep the vest free of charge.

I have a suspicion the RespirTech would tell you something similar (not the same type of story maybe) but they should tell you to take the vest and not to worry about the purchase price. If push comes to shove the worst they can do is take the machine back -- I don't think they can force you to keep it and pay for it.

Just ask them about the "what ifs" I suspect they will stay "we do whatever it takes to keep the machine in the house" -- especially if you tell them that's what Hill-Rom says !

I also think that with dual insurance coverage, they will be willing to take their chances.

Another thought is .... it is very likely you will get improvement and your doctor will be willing to back that up in writing so Medicaid will pay -- all it takes if for you to say you are coughing up more sputum (and you will) and that is improvement (most doctors are very willing to help you out in any way possible to get a vest in the home)

My son just increased his FEV1 by 11% (from 74% to 85%) when he started Pulmozyme, Hyptertonic Saline and the RespirTech vest for 7 weeks.

Short story -- let them ship the vest -- use it -- feel better! I really think you have a good shot at either one of your insurance companies paying for most if not all of the vest - or at the very least one of them will agree to pay the rental fee forever -- and that would not cost you a penny.

Good luck

Alyssa · Sep 13, 2007

We own both a RespirTech & Hill-Rom vest.

Hill-Rom specifically told me to take the vest and don't worry about insurance - they do whatever it takes to keep the vest in the home. He said they may swap out the machine (take the brand new one back and replace it with a rental unit if need be, but we would keep a machine) Our rep also referenced a story about on person keeping the vest through a 6 year battle with the insurance company -- at which time they finally exhausted all appeals and lost the battle. Hill-Rom told the patient to keep the vest free of charge.

I have a suspicion the RespirTech would tell you something similar (not the same type of story maybe) but they should tell you to take the vest and not to worry about the purchase price. If push comes to shove the worst they can do is take the machine back -- I don't think they can force you to keep it and pay for it.

Just ask them about the "what ifs" I suspect they will stay "we do whatever it takes to keep the machine in the house" -- especially if you tell them that's what Hill-Rom says !

I also think that with dual insurance coverage, they will be willing to take their chances.

Another thought is .... it is very likely you will get improvement and your doctor will be willing to back that up in writing so Medicaid will pay -- all it takes if for you to say you are coughing up more sputum (and you will) and that is improvement (most doctors are very willing to help you out in any way possible to get a vest in the home)

My son just increased his FEV1 by 11% (from 74% to 85%) when he started Pulmozyme, Hyptertonic Saline and the RespirTech vest for 7 weeks.

Short story -- let them ship the vest -- use it -- feel better! I really think you have a good shot at either one of your insurance companies paying for most if not all of the vest - or at the very least one of them will agree to pay the rental fee forever -- and that would not cost you a penny.

Good luck

Alyssa · Sep 13, 2007

We own both a RespirTech & Hill-Rom vest.

Hill-Rom specifically told me to take the vest and don't worry about insurance - they do whatever it takes to keep the vest in the home. He said they may swap out the machine (take the brand new one back and replace it with a rental unit if need be, but we would keep a machine) Our rep also referenced a story about on person keeping the vest through a 6 year battle with the insurance company -- at which time they finally exhausted all appeals and lost the battle. Hill-Rom told the patient to keep the vest free of charge.

I have a suspicion the RespirTech would tell you something similar (not the same type of story maybe) but they should tell you to take the vest and not to worry about the purchase price. If push comes to shove the worst they can do is take the machine back -- I don't think they can force you to keep it and pay for it.

Just ask them about the "what ifs" I suspect they will stay "we do whatever it takes to keep the machine in the house" -- especially if you tell them that's what Hill-Rom says !

I also think that with dual insurance coverage, they will be willing to take their chances.

Another thought is .... it is very likely you will get improvement and your doctor will be willing to back that up in writing so Medicaid will pay -- all it takes if for you to say you are coughing up more sputum (and you will) and that is improvement (most doctors are very willing to help you out in any way possible to get a vest in the home)

My son just increased his FEV1 by 11% (from 74% to 85%) when he started Pulmozyme, Hyptertonic Saline and the RespirTech vest for 7 weeks.

Short story -- let them ship the vest -- use it -- feel better! I really think you have a good shot at either one of your insurance companies paying for most if not all of the vest - or at the very least one of them will agree to pay the rental fee forever -- and that would not cost you a penny.

Good luck

Alyssa · Sep 13, 2007

We own both a RespirTech & Hill-Rom vest.

Hill-Rom specifically told me to take the vest and don't worry about insurance - they do whatever it takes to keep the vest in the home. He said they may swap out the machine (take the brand new one back and replace it with a rental unit if need be, but we would keep a machine) Our rep also referenced a story about on person keeping the vest through a 6 year battle with the insurance company -- at which time they finally exhausted all appeals and lost the battle. Hill-Rom told the patient to keep the vest free of charge.

I have a suspicion the RespirTech would tell you something similar (not the same type of story maybe) but they should tell you to take the vest and not to worry about the purchase price. If push comes to shove the worst they can do is take the machine back -- I don't think they can force you to keep it and pay for it.

Just ask them about the "what ifs" I suspect they will stay "we do whatever it takes to keep the machine in the house" -- especially if you tell them that's what Hill-Rom says !

I also think that with dual insurance coverage, they will be willing to take their chances.

Another thought is .... it is very likely you will get improvement and your doctor will be willing to back that up in writing so Medicaid will pay -- all it takes if for you to say you are coughing up more sputum (and you will) and that is improvement (most doctors are very willing to help you out in any way possible to get a vest in the home)

My son just increased his FEV1 by 11% (from 74% to 85%) when he started Pulmozyme, Hyptertonic Saline and the RespirTech vest for 7 weeks.

Short story -- let them ship the vest -- use it -- feel better! I really think you have a good shot at either one of your insurance companies paying for most if not all of the vest - or at the very least one of them will agree to pay the rental fee forever -- and that would not cost you a penny.

Good luck

Wheezie · Sep 13, 2007

I agree with Alyssa. I got my first vest when all I had was Medicare. Hill-Rom handled all the insurance stuff, but I DID have to verify how much I was using it. The vest people would call me every few months for an hours used count. If I fell below what was prescribed, Medicare threatened to stop paying for it...they never bought it outright; it was more like a rental. I have the newer model Hill-Rom vest now and I also have Medicare and Blue Shield. I have no idea which is primary and which is secondary, but I do know that my vest is being paid for. I have never had to pay out of pocket for any of my durable medical equipment, even when I had crappy Kaiser insurance, hehe <img src="i/expressions/face-icon-small-tongue.gif" border="0">

RespirTech should send you the vest for free, let you use it, and then bill Medicare - you shouldn't have to pay anything. I think that paperwork is just to let you know that Medicare COULD deny the claim...they send you the paperwork to cover their butts. Worst case scenario, Medicare denies it...then RespirTech should go to your secondary, Blue Shield, for the claim. If THEY deny it too, you send the vest back. Regardless, you shouldn't have to pay at all. And I can't imagine in a million years that your claim would or could ever be denied by Medicare. Like Alyssa said, even if it ends up being a battle with insurance to pay for it, you should be able to keep the vest and keep using it until it gets settled - with no out-of-pocket costs. Your CF Center will go to bat for you too.

I want to try the Respirtech vest now after hearing so many people rave about it on this forum. Let us know how you like it!! <img src="i/expressions/face-icon-small-happy.gif" border="0">

Wheezie · Sep 13, 2007

I agree with Alyssa. I got my first vest when all I had was Medicare. Hill-Rom handled all the insurance stuff, but I DID have to verify how much I was using it. The vest people would call me every few months for an hours used count. If I fell below what was prescribed, Medicare threatened to stop paying for it...they never bought it outright; it was more like a rental. I have the newer model Hill-Rom vest now and I also have Medicare and Blue Shield. I have no idea which is primary and which is secondary, but I do know that my vest is being paid for. I have never had to pay out of pocket for any of my durable medical equipment, even when I had crappy Kaiser insurance, hehe <img src="i/expressions/face-icon-small-tongue.gif" border="0">

RespirTech should send you the vest for free, let you use it, and then bill Medicare - you shouldn't have to pay anything. I think that paperwork is just to let you know that Medicare COULD deny the claim...they send you the paperwork to cover their butts. Worst case scenario, Medicare denies it...then RespirTech should go to your secondary, Blue Shield, for the claim. If THEY deny it too, you send the vest back. Regardless, you shouldn't have to pay at all. And I can't imagine in a million years that your claim would or could ever be denied by Medicare. Like Alyssa said, even if it ends up being a battle with insurance to pay for it, you should be able to keep the vest and keep using it until it gets settled - with no out-of-pocket costs. Your CF Center will go to bat for you too.

I want to try the Respirtech vest now after hearing so many people rave about it on this forum. Let us know how you like it!! <img src="i/expressions/face-icon-small-happy.gif" border="0">

Wheezie · Sep 13, 2007

I agree with Alyssa. I got my first vest when all I had was Medicare. Hill-Rom handled all the insurance stuff, but I DID have to verify how much I was using it. The vest people would call me every few months for an hours used count. If I fell below what was prescribed, Medicare threatened to stop paying for it...they never bought it outright; it was more like a rental. I have the newer model Hill-Rom vest now and I also have Medicare and Blue Shield. I have no idea which is primary and which is secondary, but I do know that my vest is being paid for. I have never had to pay out of pocket for any of my durable medical equipment, even when I had crappy Kaiser insurance, hehe <img src="i/expressions/face-icon-small-tongue.gif" border="0">

RespirTech should send you the vest for free, let you use it, and then bill Medicare - you shouldn't have to pay anything. I think that paperwork is just to let you know that Medicare COULD deny the claim...they send you the paperwork to cover their butts. Worst case scenario, Medicare denies it...then RespirTech should go to your secondary, Blue Shield, for the claim. If THEY deny it too, you send the vest back. Regardless, you shouldn't have to pay at all. And I can't imagine in a million years that your claim would or could ever be denied by Medicare. Like Alyssa said, even if it ends up being a battle with insurance to pay for it, you should be able to keep the vest and keep using it until it gets settled - with no out-of-pocket costs. Your CF Center will go to bat for you too.

I want to try the Respirtech vest now after hearing so many people rave about it on this forum. Let us know how you like it!! <img src="i/expressions/face-icon-small-happy.gif" border="0">

Wheezie · Sep 13, 2007

I agree with Alyssa. I got my first vest when all I had was Medicare. Hill-Rom handled all the insurance stuff, but I DID have to verify how much I was using it. The vest people would call me every few months for an hours used count. If I fell below what was prescribed, Medicare threatened to stop paying for it...they never bought it outright; it was more like a rental. I have the newer model Hill-Rom vest now and I also have Medicare and Blue Shield. I have no idea which is primary and which is secondary, but I do know that my vest is being paid for. I have never had to pay out of pocket for any of my durable medical equipment, even when I had crappy Kaiser insurance, hehe <img src="i/expressions/face-icon-small-tongue.gif" border="0">

RespirTech should send you the vest for free, let you use it, and then bill Medicare - you shouldn't have to pay anything. I think that paperwork is just to let you know that Medicare COULD deny the claim...they send you the paperwork to cover their butts. Worst case scenario, Medicare denies it...then RespirTech should go to your secondary, Blue Shield, for the claim. If THEY deny it too, you send the vest back. Regardless, you shouldn't have to pay at all. And I can't imagine in a million years that your claim would or could ever be denied by Medicare. Like Alyssa said, even if it ends up being a battle with insurance to pay for it, you should be able to keep the vest and keep using it until it gets settled - with no out-of-pocket costs. Your CF Center will go to bat for you too.

I want to try the Respirtech vest now after hearing so many people rave about it on this forum. Let us know how you like it!! <img src="i/expressions/face-icon-small-happy.gif" border="0">

Wheezie · Sep 13, 2007

I agree with Alyssa. I got my first vest when all I had was Medicare. Hill-Rom handled all the insurance stuff, but I DID have to verify how much I was using it. The vest people would call me every few months for an hours used count. If I fell below what was prescribed, Medicare threatened to stop paying for it...they never bought it outright; it was more like a rental. I have the newer model Hill-Rom vest now and I also have Medicare and Blue Shield. I have no idea which is primary and which is secondary, but I do know that my vest is being paid for. I have never had to pay out of pocket for any of my durable medical equipment, even when I had crappy Kaiser insurance, hehe <img src="i/expressions/face-icon-small-tongue.gif" border="0">

RespirTech should send you the vest for free, let you use it, and then bill Medicare - you shouldn't have to pay anything. I think that paperwork is just to let you know that Medicare COULD deny the claim...they send you the paperwork to cover their butts. Worst case scenario, Medicare denies it...then RespirTech should go to your secondary, Blue Shield, for the claim. If THEY deny it too, you send the vest back. Regardless, you shouldn't have to pay at all. And I can't imagine in a million years that your claim would or could ever be denied by Medicare. Like Alyssa said, even if it ends up being a battle with insurance to pay for it, you should be able to keep the vest and keep using it until it gets settled - with no out-of-pocket costs. Your CF Center will go to bat for you too.

I want to try the Respirtech vest now after hearing so many people rave about it on this forum. Let us know how you like it!! <img src="i/expressions/face-icon-small-happy.gif" border="0">

Ratatosk · Sep 13, 2007

Both vest companies have departments which specifically deal with the insurance issues. I agree with everyone else. Have them send you the vest and let them deal with the paperwork -- they're used to dealing with all aspects of insurance/medicare coverage. We have a hill-rom one and BCBS and I think they paid all but a couple hundred dollars. And if we couldn't afford to pay that amount, they have financing available. Think they also mentioned some other options regarding an appeal process.

Ratatosk · Sep 13, 2007

Both vest companies have departments which specifically deal with the insurance issues. I agree with everyone else. Have them send you the vest and let them deal with the paperwork -- they're used to dealing with all aspects of insurance/medicare coverage. We have a hill-rom one and BCBS and I think they paid all but a couple hundred dollars. And if we couldn't afford to pay that amount, they have financing available. Think they also mentioned some other options regarding an appeal process.

Ratatosk · Sep 13, 2007

Both vest companies have departments which specifically deal with the insurance issues. I agree with everyone else. Have them send you the vest and let them deal with the paperwork -- they're used to dealing with all aspects of insurance/medicare coverage. We have a hill-rom one and BCBS and I think they paid all but a couple hundred dollars. And if we couldn't afford to pay that amount, they have financing available. Think they also mentioned some other options regarding an appeal process.

Ratatosk · Sep 13, 2007

Both vest companies have departments which specifically deal with the insurance issues. I agree with everyone else. Have them send you the vest and let them deal with the paperwork -- they're used to dealing with all aspects of insurance/medicare coverage. We have a hill-rom one and BCBS and I think they paid all but a couple hundred dollars. And if we couldn't afford to pay that amount, they have financing available. Think they also mentioned some other options regarding an appeal process.

Ratatosk · Sep 13, 2007

Both vest companies have departments which specifically deal with the insurance issues. I agree with everyone else. Have them send you the vest and let them deal with the paperwork -- they're used to dealing with all aspects of insurance/medicare coverage. We have a hill-rom one and BCBS and I think they paid all but a couple hundred dollars. And if we couldn't afford to pay that amount, they have financing available. Think they also mentioned some other options regarding an appeal process.

The VEST

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