Nebulizer Cup Not Covered Under Insurance

[Ratatosk]

I'm thinking this has to be an error or a glitch because this is so ridiculous... I figured when I got a bill, it was because our insurance gave us new cards with new numbers. I'd also gotten a statement of benefits indicating the clinic had used the old number. So I called and made sure everyone had those new numbers. I got another bill for the neb cups. And I ignored it. Got another one yesterday and called to see what the issue was...."Nebulizer cups are not considered a medical necessity" What the heck?!

I could see not covering because I ordered too many, though I don't know what number is an appropriate amount. What really fries me is I used to just pay out of pocked because it was such a hassle dealing with our local durable medical equipment provider and to tell you the truth the cost is triple!!! if I go thru insurance.

 

[Rebjane]

We are only allowed one every 6 months and have to pay a copay on that(it's so stupid) We use 8 separate nebs a day. We used to get 2 a month(got a script) but a couple years ago even with the script it was denied. So I try to get them free when I can, sometimes the CF center has them on hand or buy a dozen or so with HSA savings. Annoying, what insurance won't pay; could make a stink about it just don't have the energy. That's how the insurance companys win, suck the life out of you. Also won't pay for the Miralax that my daughter takes 2x a day every day. Even the HSA makes us get a script and letter of medical necessity.

 

[Ratatosk]

I think I'll just go back to paying out of pocket. It's what I do with the disposable ones when we travel. Last year, since we'd met our out of pocket deductible, I ordered up 6 because that's how many nebs he does a day and it was covered by insurance.

And I'll admit, I can get the same neb cup for less than $15 when the provider was charging $45!!! for the same thing. Kinda makes me ill.

Hubby called the insurance and asked why it was deemed medically unnecessary, comparing it to a diabetic receiving insulin, but not allowed to have syringes. Insurance will review over the next 4-6 weeks, DH also filed an appeal. Sigh.

 

[Ratatosk]

Just a little update on our non-covered nebulizer cup drama. Just got a statement of benefits from insurance showing why they denied the request and included ALL neb cups ordered this year. I mistakenly assumed I had ordered one too many because they covered them 100% last year. Apparently the diagnosis (cystic fibrosis) doesn't allow for coverage of nebulizer cups. I think they're still reviewing my husband's appeal. Meanwhile I've heard from a relative who works for a DME (durable medical equipment) provider that provides equipment to nursing homes who indicated they're going thru the same things with being able to provide neb cups to patients -- it takes several tries entering a different code by the health care provider.

After YEARS of just paying out of pocket, I went thru the DME for convenience sake --- lesson learned. It isn't worth the stress. I realize the amount charged is a drop in the bucket, all things considered, but knowing what I know now, I would have ordered online and paid a much lower price.