Fight with medical group- third round
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.
RE: Fight with medical group- third round
Doesn't it fall under one of the standard HCPC codes for mask cushions?
RE: Fight with medical group- third round
Nope. Sorry. We therefore suggest that you not breathe.
If however you find you MUST breathe, try not to make a habit of it.
"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton
RE: Fight with medical group- third round
(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.
RE: Fight with medical group- third round
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