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Portable Oxygen Concentrator Resource Center

The Truth About Insurance and Medicare Reimbursement

Posted by Duke on Dec 22, 2016 11:23:11 AM

The Truth About Insurance and Medicare Reimbursement

The #1 Question We Get Asked

The number one question we get asked from patients everywhere is, “Will insurance or Medicare pay for my portable oxygen concentrator?”


In a perfect world, every medical expense you incur would be covered by insurance or Medicare. We would absolutely love to get all of our patients the machine they want with $0 out of pocket. It would benefit everyone in the industry from patients to health care professionals to health care businesses.

 

The Medicare and Insurance Run Around

Medicare Insurance Runaround

The unfortunate reality is that not everyone can get their concentrator covered by Medicare or insurance. For example, if you’re under Medicare Part B these are the requirements that you need to meet in order to qualify for coverage on your oxygen therapy:


  1. A doctor has determined that you have a severe respiratory disease or hypoxia symptoms that will improve with oxygen therapy.
  2. A blood gas study has been conducted by your doctor while you are not experiencing an exacerbation or dealing with an illness to ensure the results are accurate.
  3. Alternative measures have been tried to alleviate your respiratory symptoms and were deemed ineffective.

If you meet the Medicare requirements your doctor will be able to issue a detailed written order, but that doesn’t guarantee you will get covered.


You know how Medicare and insurance companies work… If they can find a way to deny coverage they will. So with that being said, your detailed written order needs to be absolutely flawless. Here are just some reasons Medicare will deny your claim:


  • Test results are incomplete or missing
  • Missing or incomplete detailed order from your doctor
  • Missing mobility certification
  • Missing or outdated certificate of medical necessity
  • Missing oxygen prescription
  • Missing documentation
  • If you only need oxygen at night (Medicare only covers oxygen therapy if it’s needed 24/7)

This is where the process of getting your concentrator covered by Medicare gets increasingly frustrating…

 

Even if you meet all the criteria, have flawless paperwork, and jump through all of their hoops they can still dictate which oxygen delivery system you will get. Not only can they dictate the oxygen delivery system you get, they can drag their feet during the process and make you wait to get the equipment you need. 

 

Medicare Budget Cuts Continue to Happen

Medicare Budget Cuts

So despite the fact that Medicare and insurance companies state that they will cover portable oxygen concentrators, here’s the real story:

Over the past several years the amount that Medicare has allowed for oxygen therapy has declined. In July of this year Medicare phased in a budget cut for home medical equipment. Oxygen concentrators received a budget cut of nearly 55%...


This fact alone causes Medicare to find “cheaper” alternatives to a concentrator.


So rather than getting you the equipment you need/want, Medicare and insurance companies opt to rent you tanks at a monthly fee rather than pay more upfront for a concentrator. In turn, this causes them to collect years of monthly payments when they could actually pay off the price of a concentrator in half the time.


We tried our hand in the Medicare reimbursement area and had very little success getting our patients concentrators covered through their Medicare plan. Despite the struggles we faced, we knew we had to find other ways to help patients get their machines without paying a lump sum out of pocket.

 

Our Solutions to the Medicare and Insurance Reimbursement Problem

 

Buying in Bulk and Cutting Our Prices

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We decided there has to be a better way. So we have put together a few different programs to help you get the oxygen concentrator that you need.  Our most popular route is buying a very large quantity of oxygen concentrators from the big manufacturers to keep ours and your prices very low for a new oxygen concentrator.  Our prices are so low, the manufacturers will not even let us place our prices on our website.  You can click here to download our lowest prices on new portable oxygen concentrators.

 

Offering High Quality Used Portable Oxygen Concentrators

Our next solution is our large selection of barely used portable oxygen concentrators.  We purchase barely used, and reconditioned units at even lower prices.  Our used machines go through many different tests to insure you get a unit that is just like new. You can learn more about our used portable oxygen concentrators here!

 

Providing You With An Option to Finance a Concentrator with Low Monthly Payments

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A third option is our financing program. With our financing programs, you are able to get the portable oxygen concentrator that will work best for you by making low monthly payments. And the best part is, after you finish making payments, you own the equipment outright. You can request more information on our financing program here!


Call us today and receive some more FREE information on how you can get your freedom back with a portable oxygen concentrator.  

 

If you aren't sure about which portable oxygen concentrator will work best for you, download our FREE portable oxygen concentrator comparison cheat sheet!

POC Comparison Sheet Download

Topics: portable oxygen concentrators, Insurance and Medicare Coverage

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