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Ever heard of a lifetime limit on oxygen?
Neither had Representative Steve Walsh when Apria Healthcare called recently. Walsh says the agent informed him that Walsh's one year old son had hit his lifetime limit. The toddler has been in and out of the hospital since birth and is sometimes on oxygen while recovering at home.
"Well, come pick up the tanks," Walsh challenged Apria. "We can't do that," the agent told Walsh, "because the oxygen is medically necessary." Confused, Walsh says he asked to speak to a local company representative, but has not spoken to anyone yet. But he admits he has let some calls go to voicemail.
Walsh told the story this morning to a group of health care leaders gathered at a Massachusetts Health Council forum. He sees it as an example of how patients must push back when a health care provider tries to shut off a service. "What happens," Walsh wonders, "to patients who don't know how or when to stand up for themselves?"
Apria Healthcare Executive VP Lisa Getson says this is a case of misinformation and miscommunication. She's says Walsh's insurer, Unicare, told Apria that the family had reached its max for oxygen supplies. Apria passed the message to Walsh. But then Unicare reversed itself, according to Getson.
So is there a lifetime limit on oxygen or the related equipment in Massachusetts?
Here's the state rule about what health insurance must provide to meet the "minimum creditable coverage" standard. A health plan "may not impose an overall annual maximum benefit limitation based on dollar amount or utilization that caps covered core services, whether individually or collectively, for a year or for any single illness or condition. (503.2.f.2). It looks like this would apply to oxygen. Does anyone know otherwise?
One sidebar, I didn't realize that the Food and Drug Administration regulates oxygen as a "medical gas," and requires regular prescription renewals.
This program aired on June 12, 2012. The audio for this program is not available.
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