Insurance Question

J

jonandlindsay

New member
I am in the beginning stages of getting The Vest for my 2 1/2 yr. old daughter and was told today her insurance coverage has a $3000/yr. maximum per individual. Does that mean that they will, in no way, pay more for the vest? I feel like we are at a time when we need to get the vest for her soon, but certainly can't afford over $12,000 of the cost ourselves. I'm just trying to figure out if I'm persistant enough and fight this out, if there is any way I can win this, or if it states in the policy that there's that $3000 limit that there's no way around it. Any insight anyone? Ugh.... insurance issues are awful. Thanks for any help!

~ Lindsay
Ella's Mom
 
J

JazzysMom

New member
The company will usually bill the insurance carrier according to the benefits available. Mine was "leased" for the allowed amount for the benefit period until the "purchase" price was reached then it was mine. Even if that takes years. If you are in doubt check with the company & they will explain how it will be handled.
 
A

Alyssa

New member
Lindsay,

You can read my blog about vest options -- but the short answer is:

Call The Vest people at Hill-Rom ~ they will bring you out a brand new vest and tell you "don't worry about paying for it" If there is ever a question about a fight they will do it for you. They will fight for years on your behalf and they are committed to keeping the machine in your home during the fight and after. And, yes, just like Melissa said a lease/purchase it most common ~ they told me most insurance company do not fork over the entire purchase price at one time, they will make monthly payments for a least a year and they will check with you once in a while to make sure you are still using the vest (they have an hour meter -- they just call and ask you to tell them the number)

My best advice is call Hill-Rom, get the machine, enjoy it and don't worry about the rest... just use the machine !!
 
M

Missyp8

New member
Lindsay-
First check with your insurance company to see if there is a max. There could be, but there might be a loophole that allows your doctors to give more information to the insurance company so they can cover the entire vest. If it turns out that all it will pay is the 3000, check with your cf clinic to see if they have a special commission that will help you pay. All it takes it filling out some paper work and they may cover the rest of the bill. If you clinic doesn't know then check with the local cf chapter. Hope this is helpful. Missy mom of Jake 6 w/cf
 
J

julie

New member
The vest is considered DME (Durable Medical Equip.). Many insurance companies have different maximums for DME items and as others have said, many will lease out a product for years and then once the purchase price is attainable, pay it off completely in that last year.

I would check with the Vest company first to see if they are familiar in working with your specific insurance company (they are GREAT about answering questions, doing research, fighting for coverage for people...). If that doesn't get you answers (and I really dobut you'll end a phone conversation with hill rom that way) then call your ins. company and ask about how they bill DME and what the max. for that is. You could do both, just so you are familiar with your ins. company's policy. But to save yourself some frustration, I'd start with HillRom first!

Best of luck,
 
N

NoExcuses

New member
<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>jonandlindsay</b></i>

I am in the beginning stages of getting The Vest for my 2 1/2 yr. old daughter and was told today her insurance coverage has a $3000/yr. maximum per individual. Does that mean that they will, in no way, pay more for the vest? I feel like we are at a time when we need to get the vest for her soon, but certainly can't afford over $12,000 of the cost ourselves. I'm just trying to figure out if I'm persistant enough and fight this out, if there is any way I can win this, or if it states in the policy that there's that $3000 limit that there's no way around it. Any insight anyone? Ugh.... insurance issues are awful. Thanks for any help!



~ Lindsay

Ella's Mom</end quote></div>

Is that a $3,000/year out of pocket????

Or benefits cannot be higher than $3000?

I think the annual out of pocket is more likely.
 
You must log in or register to reply here.
Top