Oxygen bureaucracy

[Stephen Tashiro]

What's caused the bureacratic tangles for patients trying to fill prescriptions for oxygen equipment?

A firend of mine has a prescripton for a small portable oxygen unit. The equipment rental company says they can't fill it unless they get a prescription to "test" him. His doctors assitants have been asked to write the prescription. Nothing is happening.

I thought his problem was unique. However, I mentioned it to my own doctor. She said that in past year, getting oxygen equipment for patients has become complicated. Each of the equipment rental companies has different requirements. Not only do they want different paperwork, they want different tests performed. (The rental companies themselves perform these tests.) Some want "sleep tests" done. Even patients who have been on oxygen for years are being required to get tests.

I assume the complications concern getting approval from Medicare or insurance companies to pay for the equipment. I hope that a person willing to pay the costs himself can still get a prescription filled without the hassle.

[Mike Henderson]

I never heard of this, and would be suspicious of any provider who wanted to administer "tests" themselves. Sounds like they just want to make a few more dollars.

My wife (now deceased) was on oxygen for a long time and we never had any problems like this.

Mike

[Jerry Thompson]

I am an RN and I do home health care. To the best of my knowledge when O2 is ordered there has to be a "Need" for it. When ordered and Medicare is paying for it a sleep study has to be done, usually by the O2 vendor. The patient has to have X amount of episodes where the blood oxygen level goes below X % for so many times and duration. It may be that insurance companies require similar validation.
When I measure a person's O2 level, using a finger sensor, and it is below 90% I need to evaluate him further. If it will not go up to 90% or better then I need to call the Physician and/or Emergency services.
If a person pays for it privately I am not sure. If I were a Physician I would want to know if the patient needs it and if so why. Oxygen is considered a medication and should be prescribed properly.

[John Pratt]

Caveat: I am not a doctor, Nurse, HHP, Insurance provider, O2 vendor, etc...

Could it have something to do with the vendor getting reimbursements from the insurance company. If they cant provide the need, they dont get reimbursed or maybe different ailments get reimbursed at different rates. Just pondering a possibility.

[Kev Williams]

I don't know what the rules are, but my wife went thru the same thing recently, had the sleep test done- twice. Her 02 level dive when she sleeps, so she sleeps with oxygen.

I think part of the issue is to weed out the frivolous users, such as hypochondriacs who 'just know' they need oxygen and their doctors just go along with it. Also, I would think they have to determine how much oxygen you need, too much is no better than not enough.

What speaks loudest to me, is that your friend's 'doctors assistants' have done nothing in response to a request for a simple prescription...

[Jerry Thompson]

John;
The patient would have to have gone through a diagnostic process to obviate a possible need for O2 such as a ICD-9 code for COPD as an example to warrant the test. The test results are machine recorded and have to be presented to whomever for justification of the use of oxygen.
Sure it can be faked. This might be more prevalent in small companies. Larger companies would have a whistle blower or two that would put folks in trouble.
I have never seen a patient using it that did not need it. I have seen people that need it but don't have it or for reasons unknown it was taken away.

[Stephen Tashiro]

My friend got his "oxygen test". The rental company said it was given by "our driver". The results aren't sent to any doctor. I went to rental company office and got the written results. The test is not a test of whether the patient needs oxygen. It is a test of whether the patient's oxygen levels are adequate using oxygen equipment at various rates of flow. The paperwork shows oxygen levels and pulse rates for "sitting" and "walking" using 1 liter per minute and 2 liters per minute.

Medicare and Insurance companies mandate this test, but it has nothing to do with proving that a patient needs oxygen. It only verifies that the patient does well when on oxygen - a patient might also do well without it.

Medicare won't pay for my friend's oxygen since the prescription is for oxygen "as needed" ("PRN"). The economical soluiton will be to use small oxygen tanks ($20 per refill) instead of renting a small oxygen concentrator ($400 per month).

If my friend had been prescribed oxygen while sleeping, there would be an oxygen "sleep test". I suspect this test verifies that the patient does OK with the oxygen equipment while sleeping, not that they really need it.