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.
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.These “noninvasive” ventilators help patients breathe around the clock by forcing air into the lungs, often through a mask.
Those guidelines give insurers room to reject many ventilator requests, even those for seriously ill patients, said Dr. John Hansen-Flaschen, a pulmonary medicine expert with the University of Pennsylvania. “I said, ‘I can feed him, I can help him go to the bathroom, I can move him from one place to the other,’” the Winfield, West Virginia, resident recalled. “The only thing I cannot do is breathe for him … and he can’t breathe.”Doctors caring for Armant, who lives outside New Orleans, say they usually get decent ventilator coverage.
Coverage complications aren't limited to UnitedHealthcare. DeMarco, the Temple student, said Aetna denied a request for a second breathing machine, and then several appeals. Eventually, his father’s employer essentially overruled the insurer and allowed coverage. Ventilator coverage problems started picking up after technology improvements made the devices easier to use, according to Dr. Lisa Wolfe, a professor at Northwestern’s Feinberg School of Medicine. That led to a rise in use for patients with conditions that are not immediately life-threatening.ALS patients without ventilator access have limited options. They can use a device that's covered but doesn’t work as well.
Prince Edward Island is now short another family doctor, the province's health agency confirmed Thursday. Dr. Harold Molyneaux has taken an immediate leave due to medical reasons, Health P.E.I. said in a statement.As a result his Summerside clinic, which served around 2,500 patients, will close immediately.The health agency said any patients impacted by the closure will be mailed information within the next several days with instructions on how to access care, including virtual care.