What is supplemental oxygen or oxygen therapy?
Supplemental oxygen is prescribed by a physician and administered through a cannula or a face mask.
Supplemental oxygen is prescribed by a physician and administered through a cannula or a face mask.
What are my rights?
Medicare recipients have the following rights. Those with private insurance should review their health benefits and contact their insurance provider with questions.
Medicare recipients have the following rights. Those with private insurance should review their health benefits and contact their insurance provider with questions.
You have the right to continuous service. Oxygen suppliers:
- Cannot drop you, change your equipment or delivery system without approval from both you and your doctor
- Cannot change the terms of your contract regarding either your equipment or the number of tanks you receive
- Must continue to provide you services if you move to a new area - either directly or by contracting with another supplier for the remainder of your contract
You have the right to effective equipment and treatment. Oxygen suppliers:
- Must provide you with the necessary oxygen equipment accessories for the entire duration of your contract, including regulators, filters, masks and tubing
- Must provide you with working equipment and repair any broken equipment
- Must honor changes in medical necessity if your physician decides your oxygen equipment can no longer provide what you need (Note: your physician must provide a new letter of medical necessity)
Will my insurance provider pay for a portable oxygen concentrator (POC)?
Medicare and most insurance providers only cover the costs of your main source of oxygen. If you claim a POC as your main oxygen supply at the beginning of your contract, your insurance provider may pay for it. You would then have to pay for any additional equipment you need, such as a home concentrator. Please research the costs of all oxygen modalities prior to submitting an insurance claim.
Medicare and most insurance providers only cover the costs of your main source of oxygen. If you claim a POC as your main oxygen supply at the beginning of your contract, your insurance provider may pay for it. You would then have to pay for any additional equipment you need, such as a home concentrator. Please research the costs of all oxygen modalities prior to submitting an insurance claim.
What should I do if my oxygen provider is breaking the rules?
- Refuse any change of equipment or coverage. Provide your supplier with a written notice, refusing any unfair changes.
- Contact your oxygen supplier and insist that they provide you with written documentation of their proposed changes and intentions. This will be needed to file a Medicare complaint.
- Contact your physician and inform him/her of the situation.
- Ensure that your oxygen supplier is in communication with your physician and has the most recent letter of medical necessity.
- File a Medicare complaint with your written refusal notice, the oxygen supplier's documentation of changes and any medical documents regarding your oxygen needs (e.g., letter of medical necessity).
- Get the local media involved if your provider continues to break the rules.
- File an Americans with Disabilities Act complaint.
PHA can help you through this process. Contact Tim at Insurance@PHAssociation.org or 301-565-3004 x773 for assistance and additional information.
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