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Thread: Insurance vest coverage

  1. #1
    Junior Member
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    Jul 2015
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    Insurance vest coverage

    Has anyone had luck with BCBS and a vest company being considered in network? I need a vest (Iíve never had one) and the 2 companies I was working with are considered out of network and the price OOP is very high. I havenít been able to work, so I canít exactly afford the $4000 price tag right now 😳.
    Thank you!

  2. #2
    Super Moderator
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    We have BCBS and at the time had a select choice policy in which anything other than our two local clinic/hospital providers were considered out of network and we had to pay a higher copay, percentage for going out of network. With his vest though, we thought we'd have to pay 20% of the DME (durable medical equipment) cost. In working with Hill-Rom, they explained that the majority of the time, the vest is denied initially and then there's an appeal process. We had to submit information regarding hospitalizations, exacerbations, specifics on infections -- they needed to know he was on Tobi, I seem to recall. Then once they sent the vest, there were still questions as to our costs, if insurance was going to cover it. For the first year we got calls asking the number of hours of usage. Finally after the year was up we received a letter indicating the vest was ours. Not sure what our percentage was -- I know it wasn't 20%. My advice is to appeal, appeal, appeal. The vest companies and your clinic should work with you.
    Parent to a child wcf double delta f508.

    Started Orkambi July 2015
    Began Symdeko August 2018

  3. #3
    Junior Member
    Join Date
    Jul 2015
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    11
    Thank you! They havenít denied it though, but since itís out of network, we have to meet the high deductible before there is any coverage, so I donít think we would have to appeal?

  4. #4
    Super Moderator
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    I seem to recall Hill Rom and probably the other company as well, have different financing options for whatever wasn't covered by insurance. Sort of a rent to own. Just visit with the vest companies and they'll guide you through the process, they're well aware of the types of roadblocks insurance may throw at you. The vest has been around for how many years.., so it's not their first rodeo.

    Once your doctor writes a prescription, if they haven't already, then the vest companies will work with you.
    Last edited by Ratatosk; 10-04-2018 at 02:35 PM.
    Parent to a child wcf double delta f508.

    Started Orkambi July 2015
    Began Symdeko August 2018

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