Reply to Insurance Denied Coverage for Medical Equipment

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[quote=Anonymous][quote=Anonymous][quote=Anonymous]Not Medicare-specific, but hrowing out some ideas of things I'd try:

Could you buy it outright without insurance? They might not want to rent to you because an individual might stop paying.

Log into/ call her insurance and push for the exact reason for denial, the diagnosis codes, they think she has according to the paperwork they have, what diagnoses (if any) would get it covered, what does she have to try first (if anything). Push nicely but firmly, ask for supervisors, etc. I rarely get a straight answer the first time anything is denied and way more often than should be the case, there's some issues on someone else's side.

Might be a paperwork thing. So many times we've needed authorization or a doctor's notes for things, it takes iterations.

Did your mom try to order from an approved DME vendor. They might only cover McKesson or whatever and not the company the doctor sent her to.

Call the doctor. Are you sure the one he prescribed is better than the one(s) she can get with insurance? (Don't do this until you figure out why it was denied. Could be other logistics.)
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Thank you!  Frankly mom shouldn't be talking to anyone about this stuff.  She's so easily confused (no surprise since she's literally getting less than half the air she needs with each breath).  She thinks they denied the BIPAP entirely, not just a certain type.  Will call and find out the exact reason for the denial and what info insurance has.[/quote]

In general, insurance is also required to put a denial in writing. They will call first sometimes (IME), but documentation is required. So your mom should be getting communications from the insurance company in the mail or possibly electronically/via email or portal. If you are going to be helping to manage her care I'd figure out how to set up an online account and then you can monitor it for her.[/quote]

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