A fellow COPD Foundation member and all-around good guy Mike Hess is working to find solutions for our broken oxygen supply system. I pose the question Is it Broken and will list some of the things that are wrong with the way things are going as of now. I will state now that the things that I state here have not been discussed with Mike, and do not intend to infer that Mike has approved these arguments. In fact, he may disagree with many of my statements.
I do not think that this topic can be covered in one post, so I will break the problem down into sections and argue each problem one at a time.
I am going to copy and paste from Medicare.gov since almost all other insurance follows the lead of Medicare. “Medicare will help pay for oxygen equipment, contents and supplies for the delivery of oxygen when all of these conditions are met:
- Your doctor says you have a severe lung disease or you’re not getting enough oxygen.
- Your health might improve with oxygen therapy.
- Your arterial blood gas level falls within a certain range.
- Other alternative measures have failed.”
Medicare will rent the equipment for 36 months and the oxygen provider who is servicing your contract must provide maintenance and supplies for a 5-year period.
The Medicare reimbursement rate is 80% which means that the patient is responsible for 20% of the cost. If the person has supplemental insurance, then it is possible for all the cost or nearly all the cost to be covered.
Again, I am going to copy and paste from Medicare.gov. “If you meet the conditions above, Medicare oxygen equipment coverage includes:
- Systems that provide oxygen
- Containers that store oxygen
- Tubing and related oxygen accessories for the delivery of oxygen and oxygen contents
Medicare may also pay for a humidifier when it’s used with your oxygen machine.”
This all seems to be so simple and straight to the point and no one should have any problem with this, but as is the case with almost everything insurance, there are complications.
I hope that I can help all of this to make sense or at least as much sense as can be made of it.
First, to get the oxygen equipment, the doctor must write a prescription and fill out a form so that the oxygen supplier is able to provide the equipment. Here in lies the first catch. Pulmonologists tend to be terribly busy people and rely on office staff to do a lot of their paperwork otherwise they could see very few patients in a day’s time. Some of the staff are well trained and know the pitfalls in the system and others are not. The paperwork is not as straight forward as the quoted medicare.gov regulations would make it seem. For the doctor to provide oxygen for the patient a 2-page form must be filled out. This 2-page form can be found at Certificate of Medical Necessity DME 484.3 (cms.gov) .
Another issue in this process is the patient’s perception of what is going on. The patient assumes that the doctor and staff know all the options available for the patient and that they will pick the best option for them. This is a bad assumption and one that does not make sense once a person begins to understand the complexities of supplemental oxygen therapy. If the patient is ambulatory at home, then a portable method of oxygen therapy must be supplied. The patient at this point has no conception about portable oxygen mechanisms and which ones might work best for them.
If the person finds that the oxygen cylinders are too heavy for them to be able to use, they cannot exchange the tanks for a portable concentrator. The contract that they have entered with the oxygen provider is good for 5 years. To change the cylinders for a portable concentrator a new prescription must be written, and the old contract voided. Most patients have no idea that this can be done. In fairness I have been told by pulmonologists that most of them do not know that this procedure is possible.
I would suggest that the prescription should be temporary at first so that the patient, the doctor, and the provider can work out the details about what is best for the patient. The original prescription should be written merely to be able to provide the patient with the oxygen and the method to supply the oxygen be confirmed later.
An education program should be provided for the patient to help them understand how to use the equipment as well as to educate them about the options that they have. An assortment of oxygen equipment should be available for the patients to test and have hands on experience with. This education program should also provide help with the use of inhalers, nebulizers and sleep masks if needed.
#COPD Foundation #supplemental oxygen