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Ins: Limited ins coverage on needed Medical Equipment

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:29 AM in Health Insurance Issues

Posts: 6
Joined: 2009-03-11
Points: 12
OnlineDurable Medical Equipment with ins

Had back surgery 3 wks ago. Spinal fusion, l-5 disk removed, decompression. I was ordered a back brace by my doctor which cost over $1100.00. I have Blue Cross which only pays $750.00 as a maximum benefit for medical equipment in a years time.
I was also ordered a walker, which cost $155.00 and a bone stimulator, which I have no idea what that cost yet.

How do you pay for all of this, when your ins doesn't cover it? Does anyone have any answers?

Please advise,

Thanks Betty

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  • dilaurodilauro ConnecticutPosts: 9,862
    When your insurance carrier provides little towards your medical expenses and you wind up with a lot of "Your obligation for payments", you only have a couple of choices
    (assuming you want to ensure you have what is needed to prevent your medication condition from getting worse)

    1- Change Insurance Carriers. Some will pay more towards medical equipment. Though, those that do may also have higher yearly premiums

    2- Pay for it and just figure out how to cut back on other expenses.

    3- It can be potentially used for the following years' Income Tax deductions.

    4- Talk with the companies that are charging you that about. See if they will work out a deal. I know many people with limited or zero medical insurance coverage and they work out a plan. a) reduce the charges, because you have limited insurance b) put you on an installment plan.

    5- Go back to the Insurance carrier and ask for the details WHY they are only paying the amount they did. You would be surprised as to the number of people that get positive results from just one phone call. And even if you dont get what you want, dont give up, ask to speak to manager or someone in a position to make decisions. Some times this might mean getting a medical necessity document from your doctor.

    Good luck
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • If I am not mistaken, a back brace would not necessarily be considered medical equipment, so it may be paid under a different category. However, the walker would fall under the equipment category. When I was first outfitted with walker, wheel chair, shower stool, bedside potty, etc. the occupational therapist set me up with a company who provides these things to patients for free. she didn't even ask me about it, just told my husband that she would go pick up what I needed to go home. I can't remember what the company was called but I would be that there is one in every city. Basically they take donated equipment from people who no longer need it, and then give it to you on loan. You have to sign a contract that you will return it, and there must be a prescription from your doctor. I know you said you already ordered the walker, but before picking it up and paying for it, I would suggest you check into something like this. Also, the goodwill or other similar type stores may have walkers for very cheap. I know I have donated one, and have a friend who gave two of them to the goodwill.

    As far as the bone growth stimulator, these are VERY expensive, sorry to say. My doctor told me that if my insurance wouldn't cover it, he would work some kind of deal with them because his patients use so many of them. Get your doctor to be your advocate and see if he can help you out. Or see if he will pre-qualify it. Sometimes the insurance companies contact the vendor of the BGS directly and try to negotiate the cost down. Fortunately my insurance paid all of mine, but without insurance it was over $5,000. It drives me nuts that these things are not re-usable to another patient. They basically have an internal calendar and are only good for a certain number of days before they are dead. You would think the company could just replace a chip and send it out again, but it must have something to do with the sterile needs and sanitation laws.

    I hope I have been able to help in some way. Good luck.

    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • Many times the medical facility will bring the charge down to what your insurance pays...it's like some agreement between both companies. That would leave you paying little or nothing.
  • Thank you so much for your advise.

    Betty >:D<
  • I wish I would have know my ins had such a low limit, but unfortunalty, I learned too late. I could have purchase a walker at a local flea market for a small amt.
    The doctor ordered the walker while I was in the hospital and the co brought one to me, not knowing I had already reached the max with the back brace costing over $1100.00.
    The walker cost $155.00.

    Thanks again for your information

    Betty >:D<
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