Medicaid has stopped paying for oxygen, is there any body else who can help with expense?
Friend only receives social security. Makes $20.00 to much for disability, and has lung disease, Medicaid has stopped paying for oxygen although Dr. has ordered it. Is there any programs out there that can help with this expense?
Medicaid management may have adopted a policy similar to that of Medicare, which no longer provides oxygen after 3 years. The supplier said that Medicare changed its practices by instituting competitive bidding for oxygen suppliers, as well as limiting its policy of providing oxygen after 3 years.
The supplier said that this is putting a lot of pressure on suppliers, one of which we've used off and on for years will no longer be participating in the DME supply and will in fact will be dissolving its business.
The current supplier could only be uncertain about what happens in 3 years and whether or not oxygen would have to be paid out of pocket.
In 2 yeasr I'm going to be stocking up on supplies and will continue to do so as year 3 approaches. I'll also be asking the techs to provide whatever insight they can on maintenance of the equipment, should it become dysfunctional.
I don't know whether or not Medicare would provide a new concentrator.
I suspect Medicaid may have adopted a similar policy. But if so, your friend should have been notified, as it's my understanding that DMEs are in fact providing up front notice of this policy change.
Verlague, your friend's pulmonology doctor might be the person to suggest funding as these doctors are probably going to have to deal with still caring for their patients in the face of Medicare's (and Medicaid's??) changed policy.
Your friend could also inquire of his/her pulmonologist whether or not there are pulmonary rehab programs in the area. There is one in our area. At least it might help your friend improve his/her lung capacity.
In our area there's an agency which provides assistance on a variety of levels. The local Area Agency on Aging would likely have any contact numbers and/or might be able to offer insight on whether there are other programs that could assist with payment.
Maggie, the thresholds for scripts for oxygen have also changed for Medicare, and possibly Medicaid. As of a few years ago, there were 3 criteria for oxygen. I don't remember exactly but I do recall that resting and walking SAT rates needed to be at a certain level or below. There was also an overnight test to be administered, which if SAT rate reached the lower threshhold, would justify oxygen overnight, but not during the day.
What this results in is provision of a concentrator for night use, but only a few tanks allowed for daytime use, thus restricting the out of home trips an individual could safely make.
Hmmmm. Perhaps there's something you're not aware of. Like. Maybe, her lung function isn't poor enough to qualify. Rather hard to believe, though. Are you absolutely sure it's not a miscommunication with the doctor? Like his incorrectly filling out the necessary paperwork? If her oxygen level is below 90%'at rest, it's very difficult to believe Medicaid would not pay for it.
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The supplier said that this is putting a lot of pressure on suppliers, one of which we've used off and on for years will no longer be participating in the DME supply and will in fact will be dissolving its business.
The current supplier could only be uncertain about what happens in 3 years and whether or not oxygen would have to be paid out of pocket.
In 2 yeasr I'm going to be stocking up on supplies and will continue to do so as year 3 approaches. I'll also be asking the techs to provide whatever insight they can on maintenance of the equipment, should it become dysfunctional.
I don't know whether or not Medicare would provide a new concentrator.
I suspect Medicaid may have adopted a similar policy. But if so, your friend should have been notified, as it's my understanding that DMEs are in fact providing up front notice of this policy change.
Verlague, your friend's pulmonology doctor might be the person to suggest funding as these doctors are probably going to have to deal with still caring for their patients in the face of Medicare's (and Medicaid's??) changed policy.
Your friend could also inquire of his/her pulmonologist whether or not there are pulmonary rehab programs in the area. There is one in our area. At least it might help your friend improve his/her lung capacity.
In our area there's an agency which provides assistance on a variety of levels. The local Area Agency on Aging would likely have any contact numbers and/or might be able to offer insight on whether there are other programs that could assist with payment.
Maggie, the thresholds for scripts for oxygen have also changed for Medicare, and possibly Medicaid. As of a few years ago, there were 3 criteria for oxygen. I don't remember exactly but I do recall that resting and walking SAT rates needed to be at a certain level or below. There was also an overnight test to be administered, which if SAT rate reached the lower threshhold, would justify oxygen overnight, but not during the day.
What this results in is provision of a concentrator for night use, but only a few tanks allowed for daytime use, thus restricting the out of home trips an individual could safely make.
Rationale? Who knows.
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