Vest and Insurance

LouLou

New member
So I've had the Vest model 104 since 1998 and heard about the lovely model 103 through this site. I called The Vest company and asked them about getting the new model because it sounds great. I was surprised when she said she'd check to see if I qualified. Upon asking her what this was all about she told me that this checks to see if my Vest was paid for. I qualified.

She went on to explain a trade in program where they take my old model 104 and refurb. it if necessary and give it to people that don' t have insurance that cover the Vest. They give my insurance company a break of 10K and only charge them 6K. Now the thing is they do this because they want to help convince the insurance company to 'appove' the coverage because it's not really a 'medical necessity' to upgrade from the 104 to the 103 because it functions the same as the 104 merely just a size and weight difference (major difference in my mind!). The Vest Company doesn't actually help all that much with the insurance / dr.'s notes etc. anymore like they used to. I told her it didn't matter because I have different insurance - meaning a new insurance policy... a new Vest, right? It's not like my new insurance could know I have a Vest could they? Isn't that sort of info. protected under HIPAA? I told her to send me the trade-in packet and also to send me a packet as if I were a new patient to the Vest. She thought I was crazy but you have to know that I have changed insurance 3 times since '98 so why does my current insurance need to reap rewards of some other insurance's payment for the Vest which I think was more like 25K back then. Make sense? I'm not all about screwing the insurance companies don't get me wrong. The fact is I've found them all about screwing me and if I come to my insurance with a request for something I don't already have they are more likely to cover it than say going to them wanting the 'travel' version of this or that DME. I have had some good and some bad experiences getting portable air compressors covered through various insurance companies so this has left me sour. I actually am in the process of getting a trek (with a back up plan of another Pro Neb if they reject my request which I halfway expect) so I guess that will give me a indicator of how they view portable DME. By the way, I plan to give my old Vest to someone who doesn't have insurance to cover it so that's not the issue at all.

My question to you all is has anyone had any experience on this subject of Vest model 103 insurance coverage - trade-in vs. newbie? or knowledge of HIPAA laws to do with this? thoughts on the subject?
 

LouLou

New member
So I've had the Vest model 104 since 1998 and heard about the lovely model 103 through this site. I called The Vest company and asked them about getting the new model because it sounds great. I was surprised when she said she'd check to see if I qualified. Upon asking her what this was all about she told me that this checks to see if my Vest was paid for. I qualified.

She went on to explain a trade in program where they take my old model 104 and refurb. it if necessary and give it to people that don' t have insurance that cover the Vest. They give my insurance company a break of 10K and only charge them 6K. Now the thing is they do this because they want to help convince the insurance company to 'appove' the coverage because it's not really a 'medical necessity' to upgrade from the 104 to the 103 because it functions the same as the 104 merely just a size and weight difference (major difference in my mind!). The Vest Company doesn't actually help all that much with the insurance / dr.'s notes etc. anymore like they used to. I told her it didn't matter because I have different insurance - meaning a new insurance policy... a new Vest, right? It's not like my new insurance could know I have a Vest could they? Isn't that sort of info. protected under HIPAA? I told her to send me the trade-in packet and also to send me a packet as if I were a new patient to the Vest. She thought I was crazy but you have to know that I have changed insurance 3 times since '98 so why does my current insurance need to reap rewards of some other insurance's payment for the Vest which I think was more like 25K back then. Make sense? I'm not all about screwing the insurance companies don't get me wrong. The fact is I've found them all about screwing me and if I come to my insurance with a request for something I don't already have they are more likely to cover it than say going to them wanting the 'travel' version of this or that DME. I have had some good and some bad experiences getting portable air compressors covered through various insurance companies so this has left me sour. I actually am in the process of getting a trek (with a back up plan of another Pro Neb if they reject my request which I halfway expect) so I guess that will give me a indicator of how they view portable DME. By the way, I plan to give my old Vest to someone who doesn't have insurance to cover it so that's not the issue at all.

My question to you all is has anyone had any experience on this subject of Vest model 103 insurance coverage - trade-in vs. newbie? or knowledge of HIPAA laws to do with this? thoughts on the subject?
 

JBUCCA

New member
PLEASE I HAVE BEEN FIGHTING W/ MY INSURANCE COMPANY TO GET THE NEW SMALLER VEST AND THEY KEEP DENYING IT EVEN W/ MY DR. WRITING THE LETTERS!!! IM SO PISSED/// I DONT EVEN WANT TO GET IN TO IT
 

JBUCCA

New member
PLEASE I HAVE BEEN FIGHTING W/ MY INSURANCE COMPANY TO GET THE NEW SMALLER VEST AND THEY KEEP DENYING IT EVEN W/ MY DR. WRITING THE LETTERS!!! IM SO PISSED/// I DONT EVEN WANT TO GET IN TO IT
 

anonymous

New member
My insurance refused to pay for the newer model even with doc's notes and everything they asked for! I was irate!!! Why not do a trade in??? What's $6,000 for an insurance company?!? That's like 3 months of pulmozyme! Grrr....

Anyway, I fought with them for nearly a year. Then, finally, I took my appeal to my secondary insurance who, after more months of debate, decided to cover it! So, taken care of, eh? Well, the fact is, when I got an "EOB" from my first insurance, they had covered it!!!! After months of denying it and sending me letter after letter of denial, the vest company must have sent them the receipt afterall (even though they KNEW not to and shouldn't have), and it was covered. I was shocked. So, perhaps, to get your insurance to cover it, instead of sending in appeal after appeal, it may work to just send it in as DME and leave it at that. I don't know if they actually have to know that you already have a vest. And, it seems the vest co. only cares if ANYONE has said in writing they would pay for it. So, that's my experience.

As far as not telling a secondary insurance, I don't think I would do that personally. It will only cost them $6000 for a trade in rather than like $18000 for new. Not that I'm about saving the insurance co. money, but I would think this "could" come and bite you in the bud if they do find out. Maybe even constitute insurance fraud, wouldn't it? I just worry about the legal implications. The vest company should have more info. for you on this. I wouldn't think they'd allow one person to have 2 vests, would they? Since the first vest is always considered a "rental".

Sonia
 

anonymous

New member
My insurance refused to pay for the newer model even with doc's notes and everything they asked for! I was irate!!! Why not do a trade in??? What's $6,000 for an insurance company?!? That's like 3 months of pulmozyme! Grrr....

Anyway, I fought with them for nearly a year. Then, finally, I took my appeal to my secondary insurance who, after more months of debate, decided to cover it! So, taken care of, eh? Well, the fact is, when I got an "EOB" from my first insurance, they had covered it!!!! After months of denying it and sending me letter after letter of denial, the vest company must have sent them the receipt afterall (even though they KNEW not to and shouldn't have), and it was covered. I was shocked. So, perhaps, to get your insurance to cover it, instead of sending in appeal after appeal, it may work to just send it in as DME and leave it at that. I don't know if they actually have to know that you already have a vest. And, it seems the vest co. only cares if ANYONE has said in writing they would pay for it. So, that's my experience.

As far as not telling a secondary insurance, I don't think I would do that personally. It will only cost them $6000 for a trade in rather than like $18000 for new. Not that I'm about saving the insurance co. money, but I would think this "could" come and bite you in the bud if they do find out. Maybe even constitute insurance fraud, wouldn't it? I just worry about the legal implications. The vest company should have more info. for you on this. I wouldn't think they'd allow one person to have 2 vests, would they? Since the first vest is always considered a "rental".

Sonia
 

Faust

New member
Must suck, i've been thinkin of upgrading to the 104. I guess the best couse would be to have a different insurance company now than what you had before with the 103.
 

Faust

New member
Must suck, i've been thinkin of upgrading to the 104. I guess the best couse would be to have a different insurance company now than what you had before with the 103.
 

Alyssa

New member
Sonia, I don't think her first vest would be considered a "rental" she said it was paid for.

Lauren, I don't think HIPPA will protect you the way you think it would in this case -- usually when you order product like this you sign something giving everyone body the right to share information necessary to process the request -- for instance your doctor will need to share information with your insurance company about your diagnosis -- they will want proof that you "need" the vest (ie, your diagnosis and possibly PFT's). However that being said, I don't think they will be asking you or your doctor if you currently have a vest or not.

Also do you have the model numbers switched around? Isn't the 103 the older one, and the 104 the newest model? We are trying to get our first vest right now and I thought we would be getting the 104 and I thought it was the newest, smallest one.
 

Alyssa

New member
Sonia, I don't think her first vest would be considered a "rental" she said it was paid for.

Lauren, I don't think HIPPA will protect you the way you think it would in this case -- usually when you order product like this you sign something giving everyone body the right to share information necessary to process the request -- for instance your doctor will need to share information with your insurance company about your diagnosis -- they will want proof that you "need" the vest (ie, your diagnosis and possibly PFT's). However that being said, I don't think they will be asking you or your doctor if you currently have a vest or not.

Also do you have the model numbers switched around? Isn't the 103 the older one, and the 104 the newest model? We are trying to get our first vest right now and I thought we would be getting the 104 and I thought it was the newest, smallest one.
 

anonymous

New member
I am sure they stand behind their 104 model like they do everything else, but I would be a little cautious...I called to order some new tubes for my 103 and the lady actually was surprised I wasn't calling with a 104 issue.
I know of another company that is just starting out called Respirtech...their vest is as small as the 104 but performs a different kind of treatment using better/more advanced technology. Something to do with the vibration waves or something. I don't know if their customer service would be as good though. And I dont think they are an "in-network" provider in the eyes of the insurance companies either.
 

anonymous

New member
I am sure they stand behind their 104 model like they do everything else, but I would be a little cautious...I called to order some new tubes for my 103 and the lady actually was surprised I wasn't calling with a 104 issue.
I know of another company that is just starting out called Respirtech...their vest is as small as the 104 but performs a different kind of treatment using better/more advanced technology. Something to do with the vibration waves or something. I don't know if their customer service would be as good though. And I dont think they are an "in-network" provider in the eyes of the insurance companies either.
 

anonymous

New member
We also have a new insurance company and would love the 103 new vest. Our new insurance company won't even buy a vest for my second child with cf. They said we already had one in the home. I am thankful we do, but they didn't even pay for the first vest. This is the same insurance company that refuses to call me to let me know when they are shipping the pulmozyme, so I have had to throw away a $7,000 order 5 times in the past two years due to it arriving a day late or sitting outside in the Texas heat overnight. They are happy to send me the replacement each time. It makes me furious. I even tried to call the president of the company and no one cares. BUT they couldn't purchase a $13,000 vest.
Sharon, mom of Sophia, 4 and Jack, 2 both with cf
 

anonymous

New member
We also have a new insurance company and would love the 103 new vest. Our new insurance company won't even buy a vest for my second child with cf. They said we already had one in the home. I am thankful we do, but they didn't even pay for the first vest. This is the same insurance company that refuses to call me to let me know when they are shipping the pulmozyme, so I have had to throw away a $7,000 order 5 times in the past two years due to it arriving a day late or sitting outside in the Texas heat overnight. They are happy to send me the replacement each time. It makes me furious. I even tried to call the president of the company and no one cares. BUT they couldn't purchase a $13,000 vest.
Sharon, mom of Sophia, 4 and Jack, 2 both with cf
 

LouLou

New member
Just curious... did you tell them you have a Vest at home or is this something the allmighty insurance company knows from the vast amount of information that is shared with them?
 

LouLou

New member
Just curious... did you tell them you have a Vest at home or is this something the allmighty insurance company knows from the vast amount of information that is shared with them?
 
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