Does Insurance pay.....

[NeedSleepLA]

Does anyone know if insurance covers the cost of an oximeter.

[Wulfman]

Have you asked them?
I'm not aware of any insurance codes for them, so I doubt it. It could POSSIBLY fall under miscellaneous code E1399, but then you'd probably need a prescription for it, too.
I haven't checked lately, but four years ago, most sellers wanted/needed a prescription to sell them.


Den

[NeedSleepLA]

I haven't asked. Just figured someone else has already tried and could share before I give it a try.

[mattman]

Insurance will very rarely actually buy an oximeter since it's usually not really needed long term. A quality oximeter will usually run 500-700 bucks or so. The $100.00 or less units aren't as accurate and don't have a lot of the options the medical grade ones do, but can at least alert the average person to seek help if there is a serious problem.

What they will pay for is either an overnight or a 24 hour oximetery test.

So depending on what it is you are needing to diagnose I'm sure your doctor would write a prescription for it.

OSA by the way will typically qualify for an overnight test.

mattman

[NeedSleepLA]

Here is my insurance company's policy on oximeters.

Clinical Policy Bulletin:
Pulse Oximeter for Home Use


Number: 0339


Policy


Aetna considers a pulse oximeter for home use medically necessary durable medical equipment (DME) for members with any of the following indications:


When weaning the individual from home oxygen; or
When a change in the individual's physical condition requires an adjustment in the liter flow of their home oxygen needs; or
To determine appropriate home oxygen liter flow for ambulation, exercise, or sleep; or
To monitor individuals on a ventilator at home.


For information on the use of pulse oximetry in periodically re-assessing the need for long-term oxygen in the home, see CPB 002 - Oxygen. Pulse oximetry can be used in conjunction with infant home apnea monitoring; for information on infant apnea monitors, see CPB 003 - Apnea Monitors for Infants. Home pulse oximetry for indications other than those listed above may be considered medically necessary upon medical review.


Aetna considers the use of home pulse oximetry experimental and investigational for all other indications, including the following:


Asthma management
When used alone as a screening/testing technique for suspected obstructive sleep apnea.

I guess I will speak to my sleep doc to see if he can figure out a need, but it doesn't look good.

[Undertherainbow]

You might have to do a little research in your state (Cali?) Where I live they cant bill but DME companies do them for free with the idea that if its positive you'll have a sleep study and therefor need a friendly DME company, ie business!! You might just call a local DME and ask... and then a second one to make sure you arent getting ripped off

[NeedSleepLA]

You might have to do a little research in your state (Cali?) Where I live they cant bill but DME companies do them for free with the idea that if its positive you'll have a sleep study and therefor need a friendly DME company, ie business!! You might just call a local DME and ask... and then a second one to make sure you arent getting ripped off

LA=Louisiana, not California.

I've already had a sleep study. I definitely have OSA. During the study before titration, my SPaO2 was dropping to the mid 50s. I don't have a copy of my study. I have been on CPAP for almost 2 months. I am not falling asleep at work nor while driving anymore but I do still feel tired. My AHI numbers are below 1 at a straight pressure of 16.5cmH2O (My original titrated pressure was 15). When I told my sleep doc about this last Friday, he for some reason wants me to start at a pressure of 12 for a couple of nights and work my way up since he knows I can adjust my machine and I bring him the printed data (He thinks it is great that I look at my data and bring it to him. He said that I am his only patient that does this.).
My problem is that at the lower pressures, I am waking up with bad headaches like before CPAP. I want the oximeter to monitor my SPaO2 during my CPAP therapy, not to determine if I have OSA. I just don't have the extra $$$ to purchase one just yet and was hoping that insurance would put in their 85%.
I think I asked my DME and was told that they do not sell oximeters. I think.

[sleepy cpa]

I would suggest another sleep studay if you are not feeling that well. Usually oximeters can be loaned from DMEs or some home health care centers will allow you to rent them.

[mattman]

2 things to look at:

1) As someone already mentioned, many DME companies will provide an oximeter at no charge for a couple days as a courtesy to their patients. So talk to your DME provider and see if they can help you out. Obviously this isn't required and isn't reimburseable so don't expect it but I'd bet that in 80%+ of the cases as long as you have a decent relationship with them they will be able to help you out.

2) There are 2 different codes and criteria to look at. There is the rental or purchase of an oximeter for a patient but there is ALSO a seperate issue of an oximetery study. This is usually done by a different type of provider and again, your DME company can most likely help arrange that. The criteria are far easier since you are only trying to get covered for a single night study or 24 hour study, etc. Generally that will only require an order from a Doc and a diagnosis of something that would warrant it, like OSA. You would be getting a prescription for a specific time, like '24hr pulse ox" or "Overnight oximetery test while on CPAP" etc.

In both cases your DME provider would be able to help you get this taken care of and can usually do all the paperwork as well. So talk to them and work with them and this can most likely be handled within 24 hours.

[Undertherainbow]

1) As someone already mentioned, many DME companies will provide an oximeter at no charge for a couple days as a courtesy to their patients. So talk to your DME provider and see if they can help you out. Obviously this isn't required and isn't reimburseable so don't expect it but I'd bet that in 80%+ of the cases as long as you have a decent relationship with them they will be able to help you out.

In my humble opinion, if they dont agree to this.....you need a new DME company! And if you need a little muscle your doc should be able to apply pressure on them