There's a woman with a toddler posting on healthboards.com under the CF forum whose husband is in the military. She's been waiting to hear if they can get the vest, it sounded as if the CF clinic recommended it; however, they were denied by insurance 'cuz "the child is too young and CPT is better" I would've posted the link to this site for this woman, but Healthboards.com has very strict rules about posting links to other sites, emails, etc. Liza
You are using an out of date browser. It may not display this or other websites correctly.
You should upgrade or use an alternative browser.
You should upgrade or use an alternative browser.
The Vest
- Thread starter anonymous
- Start date
Don't take this the wrong way, I can't stand insurance crap either.
But - in my own experience, I've had a pretty easy time obtaining medical equipment, including the vest. I've had a VERY difficult time getting home healthcare services, such as in home CPT (which would be my preference).
Insurance may have a good point - if the child is too small for the vest, then its too small for the vest... the vest does have some size limitations. Of course, I'd be interested in knowing if the child's clinician recommended it, or just suggested trying it... two very different things. In my experience, clinicians often suggest trying stuff to help patients figure out what they like, which may not carry the same weight as a recommendation, or the physician saying "this child needs the vest."
Personally I agree with the insurance company that CPT is more effective for the kid, but I feel that way for children and adults. I respect the possibilities that the child may be difficult, not like CPT, there may be time/ job issues that make CPT difficult... I also see the possibility that the parents just don't want to deal with giving the child CPT everyday, and see the vest as "an easy way out". This isn't a criticism, I'm just being honest, and if there's one thing I've learned, there isn't a shortcut when it comes to CF. The parents should still press the insurance company - if the insurance company has said that CPT is more appropriate, is it willing to pay for a therapist to come in every day?
But really, if the child is difficult, doesn't like being pounded on, etc., then giving that child a vest that will possibly be placed on a setting that is too low, not used frequently enough, you aren't doing this kid any favors. A CPT therapist would establish a routine, by showing up everyday would likely increase compliance, and would provide much more effective airway clearance.
But - in my own experience, I've had a pretty easy time obtaining medical equipment, including the vest. I've had a VERY difficult time getting home healthcare services, such as in home CPT (which would be my preference).
Insurance may have a good point - if the child is too small for the vest, then its too small for the vest... the vest does have some size limitations. Of course, I'd be interested in knowing if the child's clinician recommended it, or just suggested trying it... two very different things. In my experience, clinicians often suggest trying stuff to help patients figure out what they like, which may not carry the same weight as a recommendation, or the physician saying "this child needs the vest."
Personally I agree with the insurance company that CPT is more effective for the kid, but I feel that way for children and adults. I respect the possibilities that the child may be difficult, not like CPT, there may be time/ job issues that make CPT difficult... I also see the possibility that the parents just don't want to deal with giving the child CPT everyday, and see the vest as "an easy way out". This isn't a criticism, I'm just being honest, and if there's one thing I've learned, there isn't a shortcut when it comes to CF. The parents should still press the insurance company - if the insurance company has said that CPT is more appropriate, is it willing to pay for a therapist to come in every day?
But really, if the child is difficult, doesn't like being pounded on, etc., then giving that child a vest that will possibly be placed on a setting that is too low, not used frequently enough, you aren't doing this kid any favors. A CPT therapist would establish a routine, by showing up everyday would likely increase compliance, and would provide much more effective airway clearance.
From what I read, it sounded as if the CF clinic recommended it -- wrote a script for it. Parent indicated they were struggling with their child with CPT. Also, because they were a military family -- they didn't have any family members close by to help care for the child, so they weren't ever able to go out of town 'cuz no one knows how to do CPT except them.
Just found this site. I am the woman who posted on healthboards about being denied the vest. To answer some of your questions, my son was measured and is big enough for the vest. Is was recommemded by his RT and Pulmonologist at his CF clinic. They thought that it would be good for him to have. They didn't say that he absolutely needs it but they both said that in their opinion it works better than manual CPT. My son is 21 months old and for the most part he has tolerated his CPT well, but being a toddler, he does not want to stay in the required position or sit still for as long as he needs to. In a 25 minute therapy session, about 10 minutes or so is putting him back to where he needs to be. I will admit, that we would like to have the vest for convienence. We have 2 other kids and it seems never enough time in the day. My husband is in the military and can be deployed for months at a time. All of the responsibilities fall to me, not only my CF sons needs but everything. Frankly it it a bit overwhleming. But I must add that if my sons drs had not told me that they think the vest can do a better job, I would not be pushing for it. Belive me when I say that I only want whats best for him. As far as an RT comming to do CPT, whether insurance would pay or not, my son would never go for it. He absolutely hates strangers. My mother in law came out for a visit and he would not go near her for 4 days. After that time we tried to teach her CPT so we could go out for a night and he screamed bloody murder, he would have no part of it. Anyway, I would like to thank the poster who was trying to get info for me--I really appreciate it! And thanks to others for their opinions.
What insurance do you have? Tricare? doesn't really matter, I'm just suprised they are denying it. Call Hill-rom and explain the problem. I posted on another thread and some others made the same commit that Hill-Rom will work with you to get you a vest. They feel it is very effective and want every CF patient to have one. I can't stress enough to call them and talk with them about the problem.
I feel the Vest is more effecitive then CPT if not for a simple reason, the vest works conintiously for the entire session. During my daughter's (2yr old) last tune-up she was at home for IV antiobotics through a PIC line and we had to do CPT manually. Its just harder to get good CPT coverage manually for hte little ones like that.
I feel the Vest is more effecitive then CPT if not for a simple reason, the vest works conintiously for the entire session. During my daughter's (2yr old) last tune-up she was at home for IV antiobotics through a PIC line and we had to do CPT manually. Its just harder to get good CPT coverage manually for hte little ones like that.
I agree with the previous anon poster - call Hill Rom! My 2yo daughter got the vest chortly before Christmas. They told me they would fight the insurance until they either a) paid for it, or b) denied it. If it was denied, they have a fund set up to assist in payment. They actually said they would "never take the vest away for the unability to pay for it." And yes, that is a quote. So definatly call them! Reilly wouldn't sit still for CPT, either, and now she LOVES the vest. She watches her Elmo movies while doing her treatment, and I know it is done properly. While I may agree that CPT is better for some, on toddlers it is difficult. Good luck!
In answer to some of you, Hill-Rom recieved the denial letter also and yes they will file the appeal for us. I would like to add my own personal letter to their appeal. We have Tricare, it is a covered benefit. The denial is for the pre-authorization. Tricare will not allow us to take advantage of the 30-day trial period. My RT told me that some state/federal insurances won't allow the equipment in home until it is authorized. My husband is a Major so finacially we would be able to afford it, but why should we when when it is a covered benefit. Basically, Tricare wants him to lose some lung function before they will pay. Not fair!
Dont feel guilty for wanting the vest- in my opinion anything that makes our lives easier bring it on. You sound like you have a full plate and I hope and pray that you will get it. My son is 20 and his doctor has always said whatever they will use most faithfully for CPT is whats best- that is the vest for us. It makes him independent and can do it while hes on his computer which is most of the time. Good luck. Susan
debs2girls
New member
We just got the vest last week for my daughter....I love it, I feel like I have alot more time now (I still dont get anything done).
Hill-Rom also told us the same thing as they did Cindy (reillybug) and the anon poster right above her.
I hope you can get this straightened out really soon as the vest will greatly benefit your son.
Hill-Rom also told us the same thing as they did Cindy (reillybug) and the anon poster right above her.
I hope you can get this straightened out really soon as the vest will greatly benefit your son.
I am the poster whose son was denied authorization for the vest. A nurse from Hill-Rom contacted me on Friday to see what might be done as far as an appeal. She thinks that my son having reflux might be the best shot we have. The fact that we can't do head down positions and so forth. We were told that as an infant you just don't do anything other than flat or upright and we have not been told to change this now that he's almost 2. I don't know if it is because he has reflux or not. When did all of you start really doing all the different positions? He does have reflux which was pretty bad when he was a baby. Sometimes now he'll have a "throw-up burp" but truthfully I haven't given it too much thought lately. He is and always has been on pepcid. He did have an upper GI done when he was an inpatient in the hospital when he was a few weeks old. The nurse wants to get that study and have his pulm. and us write letters also. So I guess we'll see where that takes us. Just curious, if any of you have recieved vest when your child or yourself really didn't have any lung issues yet. Thanks for all your help!
Nicole
Nicole
Nicole...
Im a military wife also, and we have the vest for our 3 year old daughter. Im curious as to what state youre in? I ask because, when we requested the Vest our doctor said something about If we were in any other state we couldnt have gotten it so fast (not sure exactly why). We literally got the Vest in a week after the authorization. Tricare can be a pain. We also struggled ALOT with doing CPT on our toddler, UNTIL we got the vest. Made all the difference in the world. Good Luck! I hope you get one soon.
Our Respiratory Therapist told us that my daughters Vest cost $16,000. I also thought we could afford it out of pocket at first until I hear the price.
Again. Good Luck!
Angela
Im a military wife also, and we have the vest for our 3 year old daughter. Im curious as to what state youre in? I ask because, when we requested the Vest our doctor said something about If we were in any other state we couldnt have gotten it so fast (not sure exactly why). We literally got the Vest in a week after the authorization. Tricare can be a pain. We also struggled ALOT with doing CPT on our toddler, UNTIL we got the vest. Made all the difference in the world. Good Luck! I hope you get one soon.
Our Respiratory Therapist told us that my daughters Vest cost $16,000. I also thought we could afford it out of pocket at first until I hear the price.
Again. Good Luck!
Angela
Angela,
We are in CA right now. When Danny was born we were in UT and his pulmonologist there said that as soon as he was big enough he could get a vest. I haven't heard about different states making a difference. Do you mind if I ask if your daughter had any resp. problems before she got her vest? If no, can I ask you what your dr said in the request letter? If you don't want to answer these questions I understand. We do know what the vest costs--we were happy that Tricare would cover it all. Just need to get that darn authorization!
We are in CA right now. When Danny was born we were in UT and his pulmonologist there said that as soon as he was big enough he could get a vest. I haven't heard about different states making a difference. Do you mind if I ask if your daughter had any resp. problems before she got her vest? If no, can I ask you what your dr said in the request letter? If you don't want to answer these questions I understand. We do know what the vest costs--we were happy that Tricare would cover it all. Just need to get that darn authorization!
We were just told at our son's visit lat monday that our insurance HMO Blue MASS will no longer cover the vest. Very upsetting. I called the case manager at HMO Blue MA and she confirmed that. I am very upset about this. Instead of fundraising for the CF foundation we will be holding our own to pay for the vest. Now that is REALLY sad....
Paula
Paula
You asked if anyone had experience getting a vest approved when there was no lung involvement yet. I just got one for my 3 year-old son who has had very little problems as far as congestion/coughing, etc. BUT, I think the kicker for us was that he has cultured PSa a couple times and the first time (at about 15months old) was admitted to the hospital. The hospital was more overkill than anything else, but I'd be willing to bet that this is the background that went into the approval case.
On a side note, I've seen mention on other threads here that vests are often available on Ebay. Worth a try if appeals fail.
On a side note, I've seen mention on other threads here that vests are often available on Ebay. Worth a try if appeals fail.
Hi Nicole,
My daughter did have resp. problems before she got the vest. She had already been in the hospital for pneumonia once, and then later for a "tune up". We were told we might have to wait for the vest because Madison was small. But I called HillRom and was informed they make a 17 inch vest for the smaller kids, as well as the 19 inch vest. My clinic knew about the Vest but for some reason none of the other patients at the clinic were using it until I got one for madison. The docs were using the Vest as a back up to regular CPT. I pushed and pushed HARD to get the Vest. It gives me the assurance that the treatment is being done the right way, without a screaming wiggling toddler adding to the mix. Were in Virginia, with the Navy. Im STILL not sure with what being in other states has to do with getting the vest either. Im asking at our next visit.
Angela
My daughter did have resp. problems before she got the vest. She had already been in the hospital for pneumonia once, and then later for a "tune up". We were told we might have to wait for the vest because Madison was small. But I called HillRom and was informed they make a 17 inch vest for the smaller kids, as well as the 19 inch vest. My clinic knew about the Vest but for some reason none of the other patients at the clinic were using it until I got one for madison. The docs were using the Vest as a back up to regular CPT. I pushed and pushed HARD to get the Vest. It gives me the assurance that the treatment is being done the right way, without a screaming wiggling toddler adding to the mix. Were in Virginia, with the Navy. Im STILL not sure with what being in other states has to do with getting the vest either. Im asking at our next visit.
Angela
My twelve year old step-son has had the vest for YEARS, tricare covered it, almost 9 years ago.
However, they have denied other equipment for my six month old whom has CF and CP. We have a place here called CRS which stands for Children rehabilitative Services, they are affiliated with the Department of Social Services and unlike most programs their income guideline is much higher, we actually qualified which is amazing. And they will cover any equipment not covered by our insurance (doctor recommended), and they have gotten us several different things.
Do you have a case worker through tricare? I do and I call her all the time, I have found her to be one of the most helpfull people in this circus of insurance crap. She seems to know almost everything, and she is so nice, and works very hard to get everything we need without going through the "normal" insurance people whom you have to tell your story to every single time you call.
HTH
Jen
However, they have denied other equipment for my six month old whom has CF and CP. We have a place here called CRS which stands for Children rehabilitative Services, they are affiliated with the Department of Social Services and unlike most programs their income guideline is much higher, we actually qualified which is amazing. And they will cover any equipment not covered by our insurance (doctor recommended), and they have gotten us several different things.
Do you have a case worker through tricare? I do and I call her all the time, I have found her to be one of the most helpfull people in this circus of insurance crap. She seems to know almost everything, and she is so nice, and works very hard to get everything we need without going through the "normal" insurance people whom you have to tell your story to every single time you call.
HTH
Jen