Vest and Insurance

[LouLou]

Just thought I'd tell you what I've found out. My insurance when asked if it would cover the Vest said yes with an Rx from my specialist (no questions asked). So I called The Vest and told them I wanted a Vest and that my doc. would send the an Rx. for it. They said great we'll call to set up delivery as soon as we get the Rx. and I asked well don't you need to make sure you get it covered first before sending it. She said no alot of times they recover the money after the unit is in place. I wasn't aware that they were still doing this. This is how I got my first Vest 10 years ago.

So I then told her that, in fact, I have a 103 and am choosing to not do an upgrade and she made me aware that when they talk to the insurance they have to tell them that I have a 103 with a lifetime warranty to boot!! What insurance, in God's name, is going to cover a device that doesn't work better than the last version and is just a smaller device?! I think it sucks that our system requires that the Vest co. divulge this information to a private business (my insurance company). Unless we have socialized medicine, why should insurance have so much power and help from the government? If anyone see's a bright side to this picture please share.

For now I am going to write up a draft for my doctor of 'A Letter of Medical Necessity' for why I need the Vest. Quality of life, blah, blah.

 

[LouLou]

Just thought I'd tell you what I've found out. My insurance when asked if it would cover the Vest said yes with an Rx from my specialist (no questions asked). So I called The Vest and told them I wanted a Vest and that my doc. would send the an Rx. for it. They said great we'll call to set up delivery as soon as we get the Rx. and I asked well don't you need to make sure you get it covered first before sending it. She said no alot of times they recover the money after the unit is in place. I wasn't aware that they were still doing this. This is how I got my first Vest 10 years ago.

So I then told her that, in fact, I have a 103 and am choosing to not do an upgrade and she made me aware that when they talk to the insurance they have to tell them that I have a 103 with a lifetime warranty to boot!! What insurance, in God's name, is going to cover a device that doesn't work better than the last version and is just a smaller device?! I think it sucks that our system requires that the Vest co. divulge this information to a private business (my insurance company). Unless we have socialized medicine, why should insurance have so much power and help from the government? If anyone see's a bright side to this picture please share.

For now I am going to write up a draft for my doctor of 'A Letter of Medical Necessity' for why I need the Vest. Quality of life, blah, blah.

 

[anonymous]

I haven't even attempted to upgrade to the new model yet (fear of rejection I guess <img src="i/expressions/face-icon-small-smile.gif" border="0"> ). However, when I upgraded from the last one, all the vest company needed from me was how much I traveled with it to warrent the smaller "travel" size. So if you emphasize the fact that you travel with it a lot, that should help. The reason the insurance companies cares, is because they want you to do the vest wherever you are to ensure you are taking your therapy, instead of it staying home and missing treatment (which could lead to hospital costs).

This doesnt mean major travel either. It could be to take to your boyfriends, daycare, work, parents...
I didn't even talk to insurance, the vest company did everything for me. Of course, that was years ago. It seems like so much has changed since then.

--Wallflower

 

[anonymous]

I haven't even attempted to upgrade to the new model yet (fear of rejection I guess <img src="i/expressions/face-icon-small-smile.gif" border="0"> ). However, when I upgraded from the last one, all the vest company needed from me was how much I traveled with it to warrent the smaller "travel" size. So if you emphasize the fact that you travel with it a lot, that should help. The reason the insurance companies cares, is because they want you to do the vest wherever you are to ensure you are taking your therapy, instead of it staying home and missing treatment (which could lead to hospital costs).

This doesnt mean major travel either. It could be to take to your boyfriends, daycare, work, parents...
I didn't even talk to insurance, the vest company did everything for me. Of course, that was years ago. It seems like so much has changed since then.

--Wallflower

 

[Bengalsfan]

Hi. I work for BCBS of Illinois, and I know different insurances vary. First of all, the HIPAA issue.....all insurance companies and providers are allowed to share information for medical purposes. For example, if you have two insurances, we are allowed to pass information between the primary and secondary for claim processing.....or if the provider has information we need they can send that to us for claim processing. As for them knowing that you had the first vest....only if you or the original company that supplied the first vest told them that you had it, which is legal for them to do. I know when it comes to DME in Illinois it must be medically necessary. I have never seen us dig into a person's past to see if they had another one....only if we had paid for it and it popped up in the system...then it wouldn't be automatically denied, we would ? why the person needed another one....if the first was broken, didn't work any longer, new improved model, etc. My suggestion would be have the vest company do a letter of predetermination for the new vest. This should include of course the medical condition and all factors of why you need the new vest. This would result in the insurance saying yes they'll pay for it or no they won't. Then you'll know for sure. And the provider HAS to do this for you if requested. I know in Illinois we try to do as much as we can for our member's....I work on the provider side of the company, but we also try to do as much as possible for the doctors, hospitals, etc as it eventually effects the member also. I know there are a lot of complaints about insurance companies, I can only speak for the one I work for and how we try to do business and I'm so sorry all of you have had run ins with other insurances. It's sad when people with illnesses can't get what they need due to technicalities. My one complaint right now with my insurance is they won't pay for the hypertonic saline because it's not FDA approved yet.....sounds like a pretty measley little complaint considering the cost of that vs. the cost of the vest. Good luck though and I would definitely have that predetermination done.

LeAndra A. Married to Jeremy 30 w/cf

 

[Bengalsfan]

Hi. I work for BCBS of Illinois, and I know different insurances vary. First of all, the HIPAA issue.....all insurance companies and providers are allowed to share information for medical purposes. For example, if you have two insurances, we are allowed to pass information between the primary and secondary for claim processing.....or if the provider has information we need they can send that to us for claim processing. As for them knowing that you had the first vest....only if you or the original company that supplied the first vest told them that you had it, which is legal for them to do. I know when it comes to DME in Illinois it must be medically necessary. I have never seen us dig into a person's past to see if they had another one....only if we had paid for it and it popped up in the system...then it wouldn't be automatically denied, we would ? why the person needed another one....if the first was broken, didn't work any longer, new improved model, etc. My suggestion would be have the vest company do a letter of predetermination for the new vest. This should include of course the medical condition and all factors of why you need the new vest. This would result in the insurance saying yes they'll pay for it or no they won't. Then you'll know for sure. And the provider HAS to do this for you if requested. I know in Illinois we try to do as much as we can for our member's....I work on the provider side of the company, but we also try to do as much as possible for the doctors, hospitals, etc as it eventually effects the member also. I know there are a lot of complaints about insurance companies, I can only speak for the one I work for and how we try to do business and I'm so sorry all of you have had run ins with other insurances. It's sad when people with illnesses can't get what they need due to technicalities. My one complaint right now with my insurance is they won't pay for the hypertonic saline because it's not FDA approved yet.....sounds like a pretty measley little complaint considering the cost of that vs. the cost of the vest. Good luck though and I would definitely have that predetermination done.

LeAndra A. Married to Jeremy 30 w/cf

 

[Bengalsfan]

I'm sorry, I didn't see your last entry before I wrote all of that.....some insurances will cover a DME item if the quality of life is bettered by that...and considering that cf already puts restrictive forces in your chest there may be hope for them paying for a lighter, more user friendly model that would lessen the uncomfortability. You might luck out anyways and find out that they'll cover a new one since they did not pay for the first. If there's any doubt at all, still have them send that letter to the insurance company to make sure if they'll cover it.

LeAndra A. Married to Jeremy 30 w/cf

 

[Bengalsfan]

I'm sorry, I didn't see your last entry before I wrote all of that.....some insurances will cover a DME item if the quality of life is bettered by that...and considering that cf already puts restrictive forces in your chest there may be hope for them paying for a lighter, more user friendly model that would lessen the uncomfortability. You might luck out anyways and find out that they'll cover a new one since they did not pay for the first. If there's any doubt at all, still have them send that letter to the insurance company to make sure if they'll cover it.

LeAndra A. Married to Jeremy 30 w/cf