Re: New topic...pulmonary rehab question

[Guest guest]

Hi... I have IPF and the pulmonary guy wrote a prescription for pulmonary rehab. Today, my insurance company turned it down. I have Capital Blue Cross, Senior Blue, PPO #1 in northeastern Pennsylvania. Apparently they feel it wouldn't improve anything enough to justify their expense. My heart guy has also urged me to get started with the therapy. I'll ask both of them to appeal Monday, but in the meantime has anybody else had this experience? Thanks.

Bill Crafton IPF Halloween (finding out wasn't a treat!) '08 A Good Credit Score is 700 or Above. See yours in just 2 easy steps!

[Guest guest]

Bill,

Appeal, appeal appeal and then appeal some more. I did pulmonary rehab in 06 shortly after I was first diagnosed. My insurance paid for it without question but I realize that doesn't always happen.

If both your cardiologist and your pulmonologist are pushing for this it's likely the insurance will pay but you will probably have to be a pain in their butts.

I'm hoping that one of our members in PA has had some specific experience with your carrier and will chime in.

Beth in North Carolina

Moderator

Fibrotic NSIP 06/06 Dermatomyositis 11/08

To: Breathe-Support Sent: Sunday, January 11, 2009 10:24:55 AMSubject: Re: New topic...pulmonary rehab question

Hi... I have IPF and the pulmonary guy wrote a prescription for pulmonary rehab. Today, my insurance company turned it down. I have Capital Blue Cross, Senior Blue, PPO #1 in northeastern Pennsylvania. Apparently they feel it wouldn't improve anything enough to justify their expense. My heart guy has also urged me to get started with the therapy. I'll ask both of them to appeal Monday, but in the meantime has anybody else had this experience? Thanks.

Bill Crafton IPF Halloween (finding out wasn't a treat!) '08

A Good Credit Score is 700 or Above. See yours in just 2 easy steps!

[Guest guest]

Bill ... No, I have never heard of ins. denying rehab if it's ordered by the dr! Do have them reapply...something as simple as the code they may have used might make a difference.

Welcome to our group!

MamaSher, age 70. IPF 3-06, OR. NasturtiumsDon't fret about tomorrow, God is already there!

Re: New topic...pulmonary rehab question

Hi... I have IPF and the pulmonary guy wrote a prescription for pulmonary rehab. Today, my insurance company turned it down. I have Capital Blue Cross, Senior Blue, PPO #1 in northeastern Pennsylvania. Apparently they feel it wouldn't improve anything enough to justify their expense. My heart guy has also urged me to get started with the therapy. I'll ask both of them to appeal Monday, but in the meantime has anybody else had this experience? Thanks.

Bill Crafton IPF Halloween (finding out wasn't a treat!) '08

A Good Credit Score is 700 or Above. See yours in just 2 easy steps!

[Guest guest]

Bill ... I forgot to add...with a PPO, at least here in Oregon, I don't need a "referral". That is what PPO means..."Preferred Physician Optional" Call your ins. company and make an inquiry about the denial/PPO.

MamaSher, age 70. IPF 3-06, OR. NasturtiumsDon't fret about tomorrow, God is already there!

Re: New topic...pulmonary rehab question

Hi... I have IPF and the pulmonary guy wrote a prescription for pulmonary rehab. Today, my insurance company turned it down. I have Capital Blue Cross, Senior Blue, PPO #1 in northeastern Pennsylvania. Apparently they feel it wouldn't improve anything enough to justify their expense. My heart guy has also urged me to get started with the therapy. I'll ask both of them to appeal Monday, but in the meantime has anybody else had this experience? Thanks.

Bill Crafton IPF Halloween (finding out wasn't a treat!) '08

A Good Credit Score is 700 or Above. See yours in just 2 easy steps!

[Guest guest]

Bill

My belief is that your submission for it went to someone who has no idea

what PF even is. It's not a matter as much about improving things

(although it will) as it is about prolonging your life and improving the

quality of your life. There is no reasonable reason to turn down rehab

for a PF patient. You must have your doctor immediately get in direct

phone communication with them. You need to talk to them as well. It is

standard protocol for a PF patient.

>

>

> Hi... I have IPF and the pulmonary guy wrote a prescription for

pulmonary

> rehab. Today, my insurance company turned it down. I have Capital

Blue

> Cross, Senior Blue, PPO #1 in northeastern Pennsylvania. Apparently

they feel it

> wouldn't improve anything enough to justify their expense. My heart

guy has

> also urged me to get started with the therapy. I'll ask both of them

to

> appeal Monday, but in the meantime has anybody else had this

experience? Thanks.

>

> Bill Crafton IPF Halloween (finding out wasn't a treat!) '08

>

> **************A Good Credit Score is 700 or Above. See yours in just 2

easy

> steps!

>

(http://pr.atwola.com/promoclk/100000075x1215855013x1201028747/aol?redir\

=http://www.freecreditreport.com/pm/default.aspx?sc=668072%26hmpgID=62%2\

6bcd=De

> cemailfooterNO62)

>

[Guest guest]

Bill

I am in Bucks County and did not have a problem with going to the pulmonary rehab classes. I went in Spring 2006, i think the copay was about $10 per session.

When the classes were over, to continue with the maintenance program, I had to pay $7 or $8 per session. Now i joined the wellness center at the local hospital because the hours are more flexible than at the rehab center. The wellness center is $40 per month.

In the meantime, since my diagnosis, i have has a few different medical plans--all Blue Cross, but different versions.

Pink Joyce IPF 3/06 Pennsylvania

Donate Life

Subject: Re: New topic...pulmonary rehab questionTo: Breathe-Support Date: Sunday, January 11, 2009, 10:24 AM

Hi... I have IPF and the pulmonary guy wrote a prescription for pulmonary rehab. Today, my insurance company turned it down. I have Capital Blue Cross, Senior Blue, PPO #1 in northeastern Pennsylvania. Apparently they feel it wouldn't improve anything enough to justify their expense. My heart guy has also urged me to get started with the therapy. I'll ask both of them to appeal Monday, but in the meantime has anybody else had this experience? Thanks.

Bill Crafton IPF Halloween (finding out wasn't a treat!) '08

A Good Credit Score is 700 or Above. See yours in just 2 easy steps!

[Guest guest]

Bill, When my Pulmonologist prescribed rehab the rehab center and I,

both called for approval before starting. We were told it was covered

100%. When they got billed for it they denied it. I got a " letter of

necessity " and gave it to the billing department. It took 2 more

tries and fially got paid by Humana. I have insurance through my

husbands employer and won't be eligible for medicare until June.

Unfortunately, it seems once we get diagnosed with PF our new job

becomes trying to stay healthy while trying not to go broke.

Best of luck to you!

33/FL/ IPF 01/06

symptoms since childhood

>

>

> Hi... I have IPF and the pulmonary guy wrote a prescription for

pulmonary

> rehab. Today, my insurance company turned it down. I have

Capital Blue

> Cross, Senior Blue, PPO #1 in northeastern Pennsylvania.

Apparently they feel it

> wouldn't improve anything enough to justify their expense. My

heart guy has

> also urged me to get started with the therapy. I'll ask both of

them to

> appeal Monday, but in the meantime has anybody else had this

experience? Thanks.

>

> Bill Crafton IPF Halloween (finding out wasn't a treat!) '08

>

> **************A Good Credit Score is 700 or Above. See yours in

just 2 easy

> steps!

> (http://pr.atwola.com/promoclk/100000075x1215855013x1201028747/aol?

redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072%

26hmpgID=62%26bcd=De

> cemailfooterNO62)

>

[Guest guest]

Hi Bill,

I am from Titusville, Pa. But live in Ga. Just south of Atlanta. My insurance is United Health Care and they only gave me a few sessions of Pul rehab. I did not use all of them as I had to drive a good ways and the cost of gas was too much. I did ride my motorcycle a couple of times to save but weather did not co-operate. I think all insurance companies are different and each case worker is different also. I had to fight for long term disability and for Social Security.

Joe Lamenski

JOE & JOANIE LAMENSKIE

IPF JAN. 2008

-- Re: New topic...pulmonary rehab question

Hi... I have IPF and the pulmonary guy wrote a prescription for pulmonary rehab. Today, my insurance company turned it down. I have Capital Blue Cross, Senior Blue, PPO #1 in northeastern Pennsylvania. Apparently they feel it wouldn't improve anything enough to justify their expense. My heart guy has also urged me to get started with the therapy. I'll ask both of them to appeal Monday, but in the meantime has anybody else had this experience? Thanks.

Bill Crafton IPF Halloween (finding out wasn't a treat!) '08

A Good Credit Score is 700 or Above. See yours in just 2 easy steps!

[Guest guest]

From your last line ...'our new job becomes trying to stay healthy while trying not to go broke' ...

Oh how true that is. This disease is jealous! It wants all we have physically, mentally, emotionally and financially. We try to hold on to spirit and sometimes even the spirit sags.

These have become the hardest years of our lives, because of high medical bills...not 100% PF but medical nonetheless.

I guess the bright side is I may be 'older than dirt' but at least I'm not under it!

I have this board and I know you 'get it'.

We don't hear from you much , I hope you are stable.

MamaSher, age 70. IPF 3-06, OR. NasturtiumsDon't fret about tomorrow, God is already there!

Re: New topic...pulmonary rehab question

Bill, When my Pulmonologist prescribed rehab the rehab center and I, both called for approval before starting. We were told it was covered 100%. When they got billed for it they denied it. I got a "letter of necessity" and gave it to the billing department. It took 2 more tries and fially got paid by Humana. I have insurance through my husbands employer and won't be eligible for medicare until June. Unfortunately, it seems once we get diagnosed with PF our new job becomes trying to stay healthy while trying not to go broke. Best of luck to you! 33/FL/ IPF 01/06symptoms since childhood>> > Hi... I have IPF and the pulmonary guy wrote a prescription for pulmonary > rehab. Today, my insurance company turned it down. I have Capital Blue > Cross, Senior Blue, PPO #1 in northeastern Pennsylvania. Apparently they feel it > wouldn't improve anything enough to justify their expense. My heart guy has > also urged me to get started with the therapy. I'll ask both of them to > appeal Monday, but in the meantime has anybody else had this experience? Thanks.> > Bill Crafton IPF Halloween (finding out wasn't a treat!) '08 > > **************A Good Credit Score is 700 or Above. See yours in just 2 easy > steps! > (http://pr.atwola.com/promoclk/100000075x1215855013x1201028747/aol?redir=http://www.freecreditreport.com/pm/default.aspx?sc=668072%26hmpgID=62%26bcd=De> cemailfooterNO62)>