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Fight with medical group- third round
#1
Today I received the rejection letter from the medical group that must approve the new soft cushion for my Seepweaver Élan mask.
The reason: It is not medically necessary under Medicare guidelines, it is only for my personal convenience.

I guess that is true I do find it convenient to breathe at night.

So starts the third round. I requested a referral to a sleep doctor to verify that breathing is not just convenient but also a medical necessity.

At least I got the response late on Friday afternoon so I can fret about it over the weekend.
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#2
Doesn't it fall under one of the standard HCPC codes for mask cushions?
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#3
Nope. Sorry. We therefore suggest that you not breathe.
If however you find you MUST breathe, try not to make a habit of it.

Smile
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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#4
(06-21-2013, 10:04 PM)Paptillian Wrote: Doesn't it fall under one of the standard HCPC codes for mask cushions?

Yes it does. They actually approved it once, but the DME could not/would not work with Circadiance. When said lets get a different DME, that is when they denied it.
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#5
Ultamatum time.
"Either you figure out a way to work with me so I get what I need, or I find someone else who will!"
Then turn on your heel and head towards the door.

They will either recant or let you go. Either way it's win-win for you.

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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