Insurance denied our request. How can I help my Mom get a portable oxygen tank?

i am on oxygen 24/7 as i have copd. i need a light weight portable oxygen tank. the one that my provider gave me is just too heavy to carry. i am disabled and have optima health and medicaid. every company i call says they don't accept medicaid. what do i do now? thanks donna

What insurance does she have? If she still has a job to go to, would that company help her at all?

I agree with the smaller concentrator, and most "lifers" have concentrators in the home, not TANKS! really important with high flow usage. I am a respiratory therapist and you need to have a talk with your home care company.. this is dark ages care here.

Another suggestion is to write your congressman or senator some actually care or they're up for election. If they forward it to Medicaid (if your Mom has it) believe me I know it will reach a nurse very quickly & she/he will HAVE t o drop everything and try to resolve your issue. Some elected officials do this for their constituents others don't good luck I know it's none of my business but I'm curious as to why she's on such a high liter flow, it's usually lower for COPD. Does she have anything else?

Kost, just re read this situation and realize telling you to contact the CEO of insurance company is little help to you. I would however try to find out who to talk to that is in charge of your states medicaid program. You may also want to contact the company directly who supplies the 02 tanks to find out if they are willing to help. They may also know of a way around waitinf for the appeals process.

What is the insurance company refusing the 02 tanks? Just read this whole thread....shaking my head! Appeals process takes a long time. I'd go straight to the CEO of this insurance company...... you should see quick action......refuse to speak to anyone but the CEO. You have the toughness in your blood your mother has. They can't refuse her because she is on Medicaid. Keep a record of everyone you talk to dates and times and what was discussed. Praying for you....

Kost there are concentrators you can get at home instead of oxygen tanks. Maybe you could get her one of those to have at work? That way there would be no tanks to deal with at all, at least not in the work place.

I'm confused. If a portable tank would only last a few minutes, is it worth fighting for? Have I misunderstood something?

I'm just curious you don't have to answer if you don't want to but usually COPDrs are on 2 liters Why is her flow rate so high? That could be one of your problems with insurance it's unusual for somebody to go higher than 2L/m if they have COPD. You might need documentation stating why the flow is so high or that she has another condition. I'd still appeal with her insurance then hit dept of public health. Always go for a second opinion from one of their doc's first if they don't agree with you then request a state fair hearing if you go right to the hearing you can't go back for a 2nd opinion & you loose one of your options. Good luck hope you let us know how it turns out

Thank you! All the positive certainly out ways the negative. Pstegman, yes she's on high flow and your totals are pretty dead on. Took her to breakfast for her bday just last weekend and we weren't gone two hours and we had to change tanks and then I had to get her home because she was running out. Agree that money management is definitely needed which is hard. She gets $5 and thinks she's rich. She's been stressed for so many years it has altered her personality. She's been that way her whole life; probably why I'm so anal. I'm not perfect but I've decided I don't want to end up like this. I'll keep everyone posted of outcome.

Unless they've denied coverage repeatedly, I would keep hammering at them (with additional support from her doctor).

kost, she can only last a couple of hours on the large tank, which means she's on a pretty high flow rate. So a small tank would only last a few minutes. An M60 tank holds 60 cu.ft. of oxygen. An M6 tank holds 6 cu. ft.
So if her M60 only lasts 2 hrs (120 minutes) the small M6 would last 12 minutes and she would need 5 per hour, or 20 tanks in a four hour shift. It simply is not a practical solution.

Kost, please try not to take the negative, judgemental responses to heart. You know your mom better than anyone, so follow your heart. Take the suggestions you find here that can help you and throw away the rest.
Many employers are very willing to make any necessary accommodations to allow people with physical or medical problems to keep working as long as they can. Your mom is fortunate to have an employer who is holding her spot for her until she can return.
I would definitely follow the appeals process with the insurance company, make sure you have a doctor that's on her side and willing to support your efforts with letters of medical necessity and possibly teleconference with you during the appeal hearings. Once you get the oxygen issue resolved, maybe you can help Mom work on money management. That's something that's hard for many of us (myself included), but it's something we can work on and continually improve.
Best of luck to you. I commend and admire you for stepping up and being the one to help your mom and fight for what she needs. Please do let us know how this turns out for you both.

Thanks everyone. Yes it's hard to explain everything on here and not leave key details out. She can't get disability because she gets social security. Also, she's currently on oxygen. Has been since she ended up having to be vented about 6 months ago. She almost died. We had seconds to make a decision to vent her or not or she would've died. She's been on oxygen ever since but the oxygen company has let her run so low that she ends up back in the hospital. And as mentioned, she can't work or go to far from home because she has the huge tanks and not to mention one doesn't last very long. She truly does want to work and is on the schedule as soon as she can get a portable tank. Again I truly appreciate all the feedback and help. Part of the problem is I don't get to see her doc that often and she says she has it figured out. She's a strong, stubborn woman who really hates rely on anyone. She's always provided for herself and she'd do anything for others. She's never been a financially sound person but she'd do anything for anyone and help anyway she could. She's done just that for her 44 yo son who has absolutely added to her financial situation.

I would call the Department of public Heath in your state and ask for the agency you need to speak with to request a second medical opinion. If that doesn't work ask for a state fair hearing. These are both free and available no matter what kind of insurance she has and as somebody else said the member prevails more frequently than not. Good luck!

It does seem in most cases unlikely that someone could work with an oxygen tank, and I think the comments about her not going back to work were in the thought that you might need a reality check, not that anyone thought you were lying.

I recall that trying to get an oxygen thing for my Mom was impossible too, and she has probably needed one most of her life, with asthma and allergies and struggling along without one when it would have helped her a lot. I don't know why oxygen is more difficult to get than prescriptions. Yes, it is dangerous and more difficult to use but so what. If you need it, you learn, and if you can't, then you don't get one, but to not have the option makes no sense. I think you are stuck, I would try what has been recommended here just in case, but you might need to look into drugs that would help her breathe like a steroid, or whatever a doctor might recommend. Just be sure to go with her to the doctor as insurance that she is getting the right information and understanding it..... not to say your Mom isn't smart, just since I don't know you, you might want to just listen to what a doctor says about it, instead of relying on what she says when it might be very complicated. Good luck.

kost1313, thanks for more information. At 68 she is not eligible for disability, is she? I think your best bet is to follow the insurance appeal procedures. I had to appeal insurance decisions MANY times in the ten years I cared for my husband. In all but one case I won the appeals and my husband got what the doctor ordered for him. It is definitely worth doing, but you have to have a doctor on your side.

I hope that getting on oxygen full time gives your mother a new lease on life.

If you had explained about your mother's work history in your first post I think we would have avoided some skepticism. Generally it is very hard for the homeless to maintain employment. We probably made some understandable but erroneous assumptions.

I hope you'll stick around. We generally are a pretty supportive bunch when we understand a situation. I'd love to hear how the appeals go for your mother.

Thanks for all the responses. She's 68 and yes I'm telling the truth about going back to work. She's worked every day since she could until she got sick. She worked in a factory for 30+ years but lost it after they shut the door. When she got sick, she then worked at local big box store and still has a job there. Just can't go back with big tanks that she can barely move and that only last couple of hours. It actually sounds like insurance is also trying to deny the big tanks too so I guess we'll just let a person suffacote to death. She's not a lazy person. Makes poor financial decision, but not lazy. As I said has worked since like 14. Really appreciate the feedback wish I could say being called a liar was what I came to the site for but I'm kind of sorry I came here. I'll keep working with her doctors. It's all just so confusing and can definitely drain you when you have your own family, career and responsibilities. She is on Medicaid.

Are you saying that after many months/years of being homeless and unemployed that now that she is on oxygen 100% of the time she would like to turn her life around and support herself? I am always in favor of self-redemption and always hopeful of improvement (Scrooge and the Grinch are among my all-time heros.) But I also agree with the posters who are a little skeptical that this is a likely scenario. If she can turn things around, perhaps with your support and help, more power to her!

Whether or not she is able to go to work, if you can help her find safe and clean housing and other supports, that would be awesome. Take hera63's advice to heart, and go through an appeals process, if Mother's doctors are willing.

How old is your mother? Does she have other health issues? If she can't work or has only limited ability to work, consider helping her apply for disability help.

Good luck to you both.

I assume your mother is not old enough for medicare. Severe COPD is not an option for employment. She should apply for SSI disability. She probably will qualify for medicaid. It is sad when a person chooses a lifestyle that eventually leads to taxpayer funded assistance, but as a human being she should not have to suffer. Insurance will pay for oxygen tanks and in home use oxygen systems with a doctors prescription. Your mother's only options is too apply for SSI disability, apply for government housing, food stamps, heat assistance and any other social programs for the poor if that is in fact where her life is now.

She is not going to change her ways, so she is not going to get any sort of welfare assistance, nor will she find a job. She has chosen a life style that gives her complete freedom, it is her choice. Let go of her.

Hi, I used to work in insurance, complaints and appeals. The first thing you need t do is file an appeal. Then you need to have as much documentation as possible from doctors, showing that this is medically necessary. You can't have too much documentation, and make sure you submit what you have to the insurance company. If they happen to deny the first appeal, then you file a second appeal, that appeal, you will go before the doctors that wok for the insurance company, the head of the appeals department, someone like me, who would process your appeal, and possibly the lawyer who works for the company. My suggestion, bring the best you can with you, maybe see if your dr would be available to teleconference with you, and be sure you bring all your documentation/ Usually, you will take that one. However, if you don't, there is one more appeal, it goes to an outside contractor to review, and those got about 70/30 in favor of the member. That's been my experience hope that helps..

Google Inogen for portable oxygen at reasonable price. Insurance will not pay for it but perhaps you could do a payment plan. It is great for traveling or work but then use the tank at home.

Go back to work? Are you telling the truth? Come on now, she needs to get the oxygen that is for sure, but she's not going back to work with or without it.

One more thought, ask the doctor to include in the letter how not having this tank would impact your moms functional life. That is to say, if she doesn't have one she can't return to work, she would be stuck in the house which could lead to further medical complications and hospitalizations and increase her cost of care in the long run. If you talk to the insurance company in terms they understand which is the almighty dollar, sometimes that will get their attention. But insurance companies are always thinking of how things affect a person's function so that's what the letter should speak to.

The first step is to ask the doctor to write a letter of medical necessity and send it to the insurance company. The letter needs to justify, very explicitly, why a portable oxygen tank is medically necessary for her. Just because an insurance company denies something doesn't mean you can't get it covered if you fight. If that doesn't work you can look into renting one from a home medical equipment company like a Apria. They could tell you about pricing and things like that. Or you could look into resources in the community that help with low cost options for things like this. Maybe call your local Agency on Aging to get some resources.