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Thread: Monarch Vest Eligibility Question

  1. #1
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    Monarch Vest Eligibility Question

    DS was denied coverage for the new Monarch vest because he has an existing vest, is doing well and because they won't cover a new vest based on convenience or new technology. Curious how others are able to get theirs covered. I've seen several individuals on social media with Monarch vests who also have Hill Rom 105 models... Out of pocket for a monarch system is $12,000+
    Parent to a child wcf double delta f508.

    Started Orkambi July 2015
    Began Symdeko August 2018

  2. #2
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    we got one. My post just got lost.

  3. #3
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    Surprised insurance did not fight us but she has had the Hill rom for over 10 years. we have a copay for rent to own, 20% of cost for 15 months til we meet our deductible. Monarch is very heavy; took a while to get used to. We also got to keep our Hill-rom. I would fight it; write a letter. We can upgrade medical equipment every 5 years. Daughter takes the monarch to school, has done it in the car. I was surprised insurance let us get one but our daughter is always on the go. If they denied us I would let them know how it would keep her mobile ,safe, and healthy. Especially when becoming a young independent adult; ie college, travel. $12,000 is nothing compared to a hospital stay.

  4. #4
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    Thanks. I'd forgotten that the first time we'd filed for the Hill Rom 104, we'd been told we'd get denied the first go around. I did get a packet of info from Hill Rom yesterday with examples on how to apply. Would be awesome for him to be able to do his vest while on the way to sporting activities or heading out of town. Seems like we're always waiting for him to get home from school, rushing thru his vest, sometimes eating his supper while vesting so we can get out the door.
    Parent to a child wcf double delta f508.

    Started Orkambi July 2015
    Began Symdeko August 2018

  5. #5
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    The RT at our CF Clinic helped us with the paperwork from Hill rom for the Monarch. Has your son had the opportunity to try on a Monarch to see if he likes it? I feel like it is better suited for a boy's body because of where the pods hit the chest. It is pretty intense Chest PT. At first I was afraid my daughter was not going to adjust to it but we are glad we have this option now.

  6. #6
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    We have a clinic appointment next month, so we'll see what RT says. I have heard people say they seem to get a better workout, that it squeezes them harder, brings up more stuff. Last month after a year, the 105 started throwing error messages and sounded a bit different. When we got the replacement, ds said that it must've been faulty for awhile as he felt he got a better work out. Managed to get a cold around the same time, so would've been nice if the machine had been functioning better. Ugh!
    Parent to a child wcf double delta f508.

    Started Orkambi July 2015
    Began Symdeko August 2018

  7. #7
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    Our clinic mentioned that they did have another request, which was appealed and denied. They will write a letter for us. They (insurance & clinic) keep mentioning that one can get a new vest after 5 years and because DS's son has been replaced recently, that's probably why it's been denied. I do have a tough time wrapping my head around that one because DS got his first vest 12 years ago, which we paid for (well a portion, insurance covered the rest). The Vest has a lifetime warranty where they replace the vest if it breaks down. I think we're on our 4th or 5th Vest. They seem to break down every 2 years, although this last one didn't even last a year. So the supposed reasoning behind DS not being eligible for a new monarch vest is because he just got a "new" albeit refurbished replacement vest a few months ago. Insurance paid a portion of the original vest price long, long ago and we haven't had any DME claims since.
    Parent to a child wcf double delta f508.

    Started Orkambi July 2015
    Began Symdeko August 2018

  8. #8
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    Have you spoken to Hill Rom? I spoke with someone at HillRom with that exact same concern because I did not want to get the Monarch if we could not still keep the Hill Rom 105. They reassurred me that since the Hill Rom was 100% paid for and under a life time warrantee that would not happen. They did mention concern since we had an upgrade at some point from a Hill Rom104 to the 105 and I pointed out we did not ASK for that upgrade then The Hill Rom Co just decided to do it( must have something to do with refurbished VEST ect) I do agree that the Hill Rom machine does need to be replaced every so often since the electronics get funky or stop working but I DO NOT think that should affect you getting the Monarch(just my opinion) It's complicated; you keep having to replace the Hill Rom because they keep giving you a refurbished machine which is within the lifetime warrantee. SO , you Never get to upgrade? It's a circular argument. Anyway, We'll see what happens when we need to replace the Hillrom 105 when it poops out next time( hoping it's not a problem)

  9. #9
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    My husband and I were discussing this on our drive back from the City after the appointment yesterday and he was going to ask. He's got all the appeal paperwork and forms at his office. You're right. The old vest has a lifetime warranty, I believe the monarch does not. Two years?

    When DS' original 104 gave up the ghost after 4 years, I was thrilled to get the upgraded 105 since it was programmable. During that time I knew people who still had the original 80 pound beast Hill Rom 103, which still worked and they had to send in, in order to get the new one. There was a huge struggle at the time getting a replacement because the reasoning was they had a vest, they didn't need a new one for convenience sake. Eventually there were others who were able to switch to the other vest company's model and get it covered because of the 5 year rule, meaning they got a new vest and were able to keep their 80 pound beast for use at home.
    Last edited by Ratatosk; 10-02-2018 at 01:34 PM.
    Parent to a child wcf double delta f508.

    Started Orkambi July 2015
    Began Symdeko August 2018

  10. #10
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    I'm guessing the reason my son's was approved is because his current 105 is 10 years old.
    Mom to Luke, 16 years old
    Diagnosed with CF at age 5 - F508 2x
    Diagnosed with Crohn's disease at age 7
    My boy is special!

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