Vest and Insurance Denial

Gentrygirl · Aug 5, 2011

Thanks, all. Edan, I figured there were others that had been through this, but really couldn't find the topic in a search. Like everyone else, juggling the demands of life and work on top of CF, I always know you all have tips that will work and save me time! Insurance companies seem so big and so hard to fight. So the smartest thing is to start by asking for a case worker from the Insurance company? I'll do that first. Intuitively, it doesn't seem like the people that are working against us are going to be the ones that will provide us help, but I'll definitely follow your advice! Thanks for the help!!

Beccamom · Aug 5, 2011

We just fought our insurance company for a vest and we did get an approval for a 6 month trial. Getting a case manager is what worked for us. It is one person you call and explain your case. I also found the approval criteria for my insurance on line so I was prepared to medically justify the vest based on theor definition of medical justification. The Vest company called for the hour use at the end of the first week. My daughter is 11 and the case manager from the insurance company called when she answered the phone the case manager talked to her about vest use and how it helped. I was glad that we had talked to her about why she was using the vest and ask her regularly how it is working so she could articulate that iknformation the the insurance company.

I am a working mom that used all of my family medical leave this year, so I completely understand the juggle. Best wishes.

Beccamom · Aug 5, 2011

We just fought our insurance company for a vest and we did get an approval for a 6 month trial. Getting a case manager is what worked for us. It is one person you call and explain your case. I also found the approval criteria for my insurance on line so I was prepared to medically justify the vest based on theor definition of medical justification. The Vest company called for the hour use at the end of the first week. My daughter is 11 and the case manager from the insurance company called when she answered the phone the case manager talked to her about vest use and how it helped. I was glad that we had talked to her about why she was using the vest and ask her regularly how it is working so she could articulate that iknformation the the insurance company.

I am a working mom that used all of my family medical leave this year, so I completely understand the juggle. Best wishes.

Beccamom · Aug 5, 2011

We just fought our insurance company for a vest and we did get an approval for a 6 month trial. Getting a case manager is what worked for us. It is one person you call and explain your case. I also found the approval criteria for my insurance on line so I was prepared to medically justify the vest based on theor definition of medical justification. The Vest company called for the hour use at the end of the first week. My daughter is 11 and the case manager from the insurance company called when she answered the phone the case manager talked to her about vest use and how it helped. I was glad that we had talked to her about why she was using the vest and ask her regularly how it is working so she could articulate that iknformation the the insurance company.
 
 I am a working mom that used all of my family medical leave this year, so I completely understand the juggle. Best wishes.

Gentrygirl · Aug 8, 2011

Beccamom: Where does one find the approval criteria online?

Gentrygirl · Aug 8, 2011

Beccamom: Where does one find the approval criteria online?

Gentrygirl · Aug 8, 2011

Beccamom: Where does one find the approval criteria online?

Sidewynnder · Aug 18, 2011

I had a vest for a while, but I no longer use it. I either do some vigorous physical activity, use an acapella, or have someone "beat me". If Logan uses it correctly, the acapella is, in my opinion, far preferred as it only takes about 5 minutes to use, and you can get one for free at your CF clinic.

Of course, the vest is nice too!

Sidewynnder · Aug 18, 2011

I had a vest for a while, but I no longer use it. I either do some vigorous physical activity, use an acapella, or have someone "beat me". If Logan uses it correctly, the acapella is, in my opinion, far preferred as it only takes about 5 minutes to use, and you can get one for free at your CF clinic.

Of course, the vest is nice too!

Sidewynnder · Aug 18, 2011

I had a vest for a while, but I no longer use it. I either do some vigorous physical activity, use an acapella, or have someone "beat me". If Logan uses it correctly, the acapella is, in my opinion, far preferred as it only takes about 5 minutes to use, and you can get one for free at your CF clinic.
 
 Of course, the vest is nice too!

Beccamom · Aug 19, 2011