My wife is a terminal emphysema patient, she has had a lung reduction surgery, and has a very poor quality of life. She struggles every day to just fight for enough oxygen to get her through the day, she can very rarely leave the house, and when she can it is only for limited periods of time due to the 4 litres of oxygen required to keep her breathing.
My employer changed insurance in August of last year. We were with the other insurance for about three years. My wife requires an oxygen concentrator for home, bottles for when she can get out, and was placed on a non-invasive ventilator to get her through the night. The other insurance paid for the ventilator, minus my co-pay, for three years with no issues. The machine helps remove the carbon dioxide from her lungs all night. Making for a better day for her the next day, and she has had to use the ventilator during the day when her oxygen levels fall low. Use of the machine pulled her oxygen levels back up, (I assume because of the removal of the carbon dioxide, allowing for better lung function)
United healthcare paid for the machine for four months, September through December, Then in April, I got a letter stating that the ventilator was “experimental” and “not medically necessary” and in May we started receiving collection calls from Apria, the provider of the machine. Note: I never received a bill other than the normal amount each month, which I have records of, and I paid the entire balance due, even though the records recently provided show that United Healthcare quit paying in January.
I have been back and forth with the non-english speaking reps from Apria, as has the advocate from the pulmonologist office, trying to straighten this out. Appeals have been filed and denied.
During this process, somehow, Apria has decided I now owe them $4500 additional dollars for the ventilator, that is due and payable immediately, even though I receive NO BILLING for that amount. Amazingly, after bringing this to their attention, a bill for that dollar amount appears added to the regular May billing. (The collection calls started in March)
United Healthcare, has taken the place of my wife’s pulmonologist, who is board certified, and an expert in his field, and determined that he does not know what he is doing. “Not medically necessary” is that for them to decide or her doctor of fifteen years? Why did the other insurance company not question the addition of the ventilator to her care?
Apria just left our house, they arrived, unannounced, and removed the ventilator from our house, and said it was the only way to “stop the billing” no alternate machine, no options, just give us our machine and sign this 30 page document in legalese allowing us to do whatever we want.
I am disgusted with the entire process, the lack of communication, and now I have a terminal wife, with no ventilator, and a bill for god knows how much that is hanging over my head, all due to the ineptness of United Healthcare and Apria.
I am not sure what to do now, a trip to the emergency room is $500.00 (also payable immediately, before any services are provided) and without the ventilator I am sure we will be there countless times. My greatest fear is now I may lose my wife of 30 years because the Trillion dollar health insurance industry decides who gets what care, not the trained doctors who deal directly with the patients on a daily basis.