Insurer delays and denials hamper patients seeking at-home breathing machines
Doctors around the country say insurers are making it harder to get coverage for home ventilators that patients with serious illnesses need as their lungs fail
Lou Gehrig’s disease took away Grace Armant’s ability to speak, but the 84-year-old still has plenty to say about her insurance.
UnitedHealthcare has rejected several requests from her doctors for coverage of a machine Armant needs to breathe as she deals with the fatal illness.
“They are no good,” Armant said, typing slowly into a device that speaks for her. “I can’t do without the machine.”
Doctors around the country say UnitedHealthcare and other insurers have made it harder to get coverage for certain home ventilators that patients like Armant need as their lungs fail. They say patients often must struggle first with less effective — and cheaper — devices before some insurers will pay. In other cases, insurers balk at paying for a second machine needed when patients transfer from their bed to a wheelchair.
Temple University doctoral student Jaggar DeMarco waited more than three years to get his.
“Breathing is not a luxury," he said. “It’s really the bare minimum, and that’s what we’re asking for.”
Some physicians believe insurers are making it harder on patients because more of the devices are being prescribed. Spending by the federal government’s Medicare program on the ventilators jumped from about $3 million to nearly $269 million between 2009 and 2017, according to the U.S. Department of Health and Human Services Office of Inspector General.
Insurers say they do cover the machines, but that coverage can depend on several factors.
These “noninvasive” ventilators help patients breathe around the clock by forcing air into the lungs, often through a mask.
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