Some insurers definitely cover chest PT. They may not want to, but if you and your docs put up a big enough fight, it is possible to get them to cover you.
Ways to make it easier:
Call your insurer and ask to have a case manager assigned to you. Otherwise, every time you call your insurance company its like starting from scratch.
Insurers HATE to cover ongoing home-based care, and will look for any reason not to do so. The favorite excuse they will try to use is that "since you're not home-bound, we don't cover it" don't let them use this. Have your doc write them a letter of necessity explaining the importance of Chest PT, and fight the suggestion of going to an outpatient setting by 1) the increased risks of infection by being around other patients who may have CF 2) The inability to do your nebs right after your session because you have to drive back to your house. Again, having a case manager who you have explained CF to, and your daily regiment to will help this.
I was also forced to get a vest first, but was able to successfully argue that it was ineffective and not cost efficient for the insurance company after needing a cleanout 3 months after a previous cleanout, using the vest in between. I was able to convince them to let me try CPT for 3 months and see if I did better, and I haven't had a cleanout since. (1 Year ago). They don't bug me anymore about paying for CPT.
Here are some reasons you can give them about why you need CPT instead of the vest:
1) The positions of CPT point my bronchial tubes toward the ground, using gravity to help clear my lungs while being pounded on - the vest doesn't
2) Stopping to rotate positions makes me stop and cough - the vest doesn't do that
3) If you find you have had compliance issues in the past, nothing makes you more compliant than having a scheduled time when your therapist knocks on the door. Tell the insurance company that with CPT they know you're using the treatment - with the vest, they pay for it whether you use it or not.
Don't be suprised if they resist paying for daily CTP, but fight with them and try to get at least 3 days a week. My current situation is 3 days a week, but daily if I am doing a home cleanout.
Good luck!
Chris
26 w/CF
Ways to make it easier:
Call your insurer and ask to have a case manager assigned to you. Otherwise, every time you call your insurance company its like starting from scratch.
Insurers HATE to cover ongoing home-based care, and will look for any reason not to do so. The favorite excuse they will try to use is that "since you're not home-bound, we don't cover it" don't let them use this. Have your doc write them a letter of necessity explaining the importance of Chest PT, and fight the suggestion of going to an outpatient setting by 1) the increased risks of infection by being around other patients who may have CF 2) The inability to do your nebs right after your session because you have to drive back to your house. Again, having a case manager who you have explained CF to, and your daily regiment to will help this.
I was also forced to get a vest first, but was able to successfully argue that it was ineffective and not cost efficient for the insurance company after needing a cleanout 3 months after a previous cleanout, using the vest in between. I was able to convince them to let me try CPT for 3 months and see if I did better, and I haven't had a cleanout since. (1 Year ago). They don't bug me anymore about paying for CPT.
Here are some reasons you can give them about why you need CPT instead of the vest:
1) The positions of CPT point my bronchial tubes toward the ground, using gravity to help clear my lungs while being pounded on - the vest doesn't
2) Stopping to rotate positions makes me stop and cough - the vest doesn't do that
3) If you find you have had compliance issues in the past, nothing makes you more compliant than having a scheduled time when your therapist knocks on the door. Tell the insurance company that with CPT they know you're using the treatment - with the vest, they pay for it whether you use it or not.
Don't be suprised if they resist paying for daily CTP, but fight with them and try to get at least 3 days a week. My current situation is 3 days a week, but daily if I am doing a home cleanout.
Good luck!
Chris
26 w/CF