portable nebulizer question--insurance related

[disfan07]

I am cross posting this on the disabilities forum as well but i figured it wouldn't hurt to ask here as well.

Has anyone on here ever bought a protable nebulizer before?
If you have...did your insurance cover it?

We need to get a portable nebulizer because we have had 2 power outages in teh past month and I was not able to use my nebulizer at the time so my doctors wrote a prescription for a portable neb.

Our insurance is claiming that it is not a necessity but a convenience. My doctor has been fighting with them because to him and to us, it is not a convenience...it is a necessity. If I am on neb treatments when the power goes out, or there are evacuations becasue of wildfires (we live in southern california), or an earthquake, we need to have a nebulizer that does not require electricity. They are still claiming that we dont really need it. The portable nebulizer costs about $400. It has nothing to do with the cost...we can afford it but we're trying to figure out what part of having a battery operated nebulizer is not a necessity especially when you are right in the middle of wildfire and earthquake zone!!!

But than again, they did not cover my regular nebulizer either because they claimed it wasnt necessary because i have my xoponex inhalers

 

[minnie1928]

I can't say whether a portable would've been covered, but my insurance covered my plug-in version. But, that was many years ago.

I agree...if you are at the point where you are using neb treatments, that can of xopenex isn't gonna cut it. If you can't breathe, how are you supposed to get the medicine in your lungs?!

 

[Jennifer in MI]

My d.s. needs a nebulizer. Our insurance did cover the portable one. They said they would cover one nebulizer every 3 years (I think). So, we made due with the electric one for the next year or so until they would pay for the portable one.

In the meantime, do you have a power converter for your car? We bought one so that when we lost electricity or when we were traveling, we could just plug it into the car. Works really well!

 

[bennyrn12]

I have both types and both were covered. The way that we got the insurance to cover my portable was by saying i would need nebs every 4 hours and I was going to be traveling and would need to use the neb on the plane. The insurance didnt give us a hard time at all with it. I actually sold my regular neb cause the portable is so much better! If all else fails I am sure you can buy one off craigslist or ebay.

 

[Kellydelly]

I would get a power converter for your car, it costs less than $20. Would that solve your problem?

 

[TupperMom7]

Our insurance covered the cost of our dd11 nebulizer, but it is the electric variety. Do they make something that runs on batteries that you can plug the nebulizer into, like a generator or something? I thought it was wonderful when dd first got her nebulizer 8 years ago - they came right to the hospital room and showed me how to use it and everything.

 

[Joyful3Heart]

I would get a power converter for your car, it costs less than $20. Would that solve your problem?

I was thinking the same thing .
I am sorry you are going through this,though. Believe it or not, we are beginning to have trouble with insurance companies covering a nebulizer for children as young as 2yo. They say studies have shown that an inhaler with a spacer delivers the same amount of medication as a nebulizer at a fraction of the cost. Okay...now picture the average 2 year old with a plastic spacer with attached plastic mask which must be sealed to his/her face for 2-3 slowly inhaled breaths as the parent is trying to press down the inhaler while their child is squirming and screaming bloody murder...how much medication do YOU think is delivered vs. 10 minutes of nebulized medication consistently in his/her inhaled air? .

 

[3boymthr]

It really depends upon what your contract states - every contract is different - some contracts don't cover DME or only cover DME for certain conditions or only cover DME after an elimination protocol has been followed - which is why you may be having trouble.

You need to check a copy of the plan document, the one that spells out exactly everything that is to be covered and not covered and the language that details, x is covered, but y isn't and the circumstance of how why and when it's covered. This should be a large document of 50 or 60 pages or more (sometimes as many as 200 pages). If you have employer sponsored health care ask your HR for a copy of it - they will have it. If you purchase your insurance directly then tell them you want it sent to you.

Also, let them know that you will be calling the local division of insurance if the protocols spelled out in the plan document don't match what they are telling you.

 

[WantToGoNow]

We called the insurance company to see if they would cover a portable nebulizer for ds8 before we went to WDW. Their answer was a swift no so we didn't pursue it further. My oldest dd works in a pharmacy and she said they are rarely covered. My dh was actually able to get a spacer for an inhaler covered 2 weeks ago - we've always had to pay for those before.

 

[smidgen21]

My BCBS covered one for DS2 who is severly asthmatic. I feel very grateful after reading the posts here.

 

[Cloudwatcher]

I was thinking the same thing .
I am sorry you are going through this,though. Believe it or not, we are beginning to have trouble with insurance companies covering a nebulizer for children as young as 2yo. They say studies have shown that an inhaler with a spacer delivers the same amount of medication as a nebulizer at a fraction of the cost. Okay...now picture the average 2 year old with a plastic spacer with attached plastic mask which must be sealed to his/her face for 2-3 slowly inhaled breaths as the parent is trying to press down the inhaler while their child is squirming and screaming bloody murder...how much medication do YOU think is delivered vs. 10 minutes of nebulized medication consistently in his/her inhaled air? .

DD1 has a inhaler with a spacer, after 9 months of doing 15-20 minutes of nebulizer treatments every 4 hours to a wiggly baby our dr said we could try. She loves it, it takes less then a minute for both treatments and then she gets her teeth brushed.
We did however get a portable nebulizer covered by our insurance because DD was on treatments every 4 hours or when she had a flare up.

 

[lovepurple]

Our insurance company would not cover our son's nebulizer because they had previously paid for one month's rental on one that he was sent home from the ER with. We went round and round with them but they still refused. The cost was going to be over $300. We then started negotiating with the company that we got the nebulizer from and they agreed to sell it to us for $90.

 

[FOXFIELDZOO]

I was thinking the same thing .
I am sorry you are going through this,though. Believe it or not, we are beginning to have trouble with insurance companies covering a nebulizer for children as young as 2yo. They say studies have shown that an inhaler with a spacer delivers the same amount of medication as a nebulizer at a fraction of the cost. Okay...now picture the average 2 year old with a plastic spacer with attached plastic mask which must be sealed to his/her face for 2-3 slowly inhaled breaths as the parent is trying to press down the inhaler while their child is squirming and screaming bloody murder...how much medication do YOU think is delivered vs. 10 minutes of nebulized medication consistently in his/her inhaled air? .

I have an inhaler with the spacer ,my son was only 9months old when he got that and he was bouncing off the walls with that we went to our regular ped and he got the nebulizer ,even though the nebulizer itself costs more the meds for it are way cheeper than the inhaler is and lasted much longer,I hate insurance somtimes, you pay so much for it and then they give you a hassel when you need something,Oh well what can you do ,can't go without it ,we are at there mercy

 

[disfan07]

Thanks for the answers.

Whether or not they cover the portable neb. we are going to buy it. It'll be much easier to travel with but also I am going away to college in the fall and it'll be a lot ore convenient to deal with that than with the regular nebulizer. I was just curious as to whether prople have ahd it covered.
We have anthm BCBS california. They are horendous to deal with (it doesnt help that they are beign investigated for price gauging either amongst other things....but thats a different story) but at this point after racking up almost $300,000 in medical bills this past year, i'm just glad we have health insurance. $400 is not going to make or break us thankfully.

Also, teh inhaler vs. nebulizer thing. When I was diagnosed, my doctors were wondering if there was a difference in lung function after my inhaler vs. after my nebulizer b/c I wasnt noticing a huge difference so they did 2 separate PFTs adn teh difference is significant...at least for me.

There is barely any difference between my before PFTs and after taking my inhaler but there is a significant difference between my before PFTs adn after a nebulizer treatment. which is why my dcotor is convinced that the protable nebulizer is a necessity not a convenience because my inhalers just are not working well for me as much anymore.

 

[MandM-Mom]

My dd AnnaBelle does not get the same results from her inhaler with spacer as she does with having a neb so our Doc wrote a letter to ins. company stating the neccessity of it and then they ended up covering the portable even though it had not been 3 years since the other larger plug in was purchased.

 

[Aristomommy]

DD1 has a inhaler with a spacer, after 9 months of doing 15-20 minutes of nebulizer treatments every 4 hours to a wiggly baby our dr said we could try. She loves it, it takes less then a minute for both treatments and then she gets her teeth brushed.
We did however get a portable nebulizer covered by our insurance because DD was on treatments every 4 hours or when she had a flare up.

Using a spacer was what sent my then 2 year old into the hospital for days. While it must work for you, it does not always deliver the same amount of meds when little ones can't coordinate their breathing to take in the medication. After a while DD got less and less of her medication and her asthma flared up. Our Dr quickly changed her back to a nebulizer and we went back to her spacer around 8 or 9. Our 5 year old still uses nebulizer because I don't want to take any chances. I am glad it work for you, but please keep an eye out for a potential flare up in little ones.