Insurer delays and denials hamper patients seeking at-home breathing machines

Lou Gehrig’s disease took away Grace Armant’s ability to speak, but the 84-year-old still has a lot to say about her insurance.

UnitedHealthcare has rejected several requests from her doctors for coverage of a machine Armant needs to breathe as she deals with the fatal illness.

“They are no good,” Armant said, typing slowly into a device that speaks for her. “I can’t do without the machine.”

Doctors around the country say UnitedHealthcare and other insurers have made it harder to get coverage for certain home ventilators that patients like Armant need as their lungs fail. They say patients often must struggle first with less effective, and cheaper, devices before some insurers pay. In other cases, insurers balk at paying for a second machine needed when a patient transfers from a bed to a wheelchair.

Temple University doctoral student Jaggar DeMarco waited more than three years to get his.

“Breathing is not a luxury,” he said. “It’s really the bare minimum, and that’s what we’re asking for.”

Some physicians believe insurers are making it harder on patients because more of the devices are being prescribed. Spending by the federal government’s Medicare program on the ventilators jumped from about $3 million to nearly $269 million between 2009 and 2017, according to the U.S. Department of Health and Human Services Office of Inspector General.

Insurers say they do cover the machines, but that coverage can depend on several factors.

“Noninvasive” ventilators help patients breathe around the clock by forcing air into the lungs, often through a mask. They are called noninvasive because they don’t require tracheal surgery to open the airway.

The machines have battery backups so they can keep working if the power goes out. They also are more powerful than other devices meant to be used mainly at night for conditions like sleep apnea. At around $1,200 a month, they can be three times as expensive as those devices.

Doctors say these ventilators can help prolong the life of someone with Lou Gehrig’s disease, also known as amyotrophic lateral sclerosis.

But insurance rejections have picked up for those patients and for people dealing with advanced cases of chronic obstructive pulmonary disease, said Chuck Coolidge, the chief strategy officer for VieMed, which provides respiratory equipment for patients in 46 states.

That includes both initial approvals and reauthorizations, he said.

UnitedHealthcare spokeswoman Heather Soule said her company covers the machines and re-evaluates requests if it gets new information. Coverage can depend on the patient’s condition, terms of the person’s health plan or on guidelines from the federal Medicare program.

Those guidelines give insurers room to reject many ventilator requests, even those for seriously ill patients, said Dr. John Hansen-Flaschen, an expert in pulmonary medicine with the University of Pennsylvania.

Government-funded Medicare Advantage plans run by UnitedHealthcare now deny nearly all initial requests for ventilators, said Dr. Cathy LomenHoerth, a neurologist with the University of California at San Francisco.

In West Virginia, Dale Harper says it took several months and a personal