Understanding HFCWO reimbursement
For patients confronted by the health challenges of impaired airway clearance, high frequency chest wall oscillation (HFCWO) is clinically proven to improve bronchial drainage, reducing the likelihood of future lung infections and other health risks and complications. That’s an important consideration in this era of growing concern over health care costs.
In fact, from the perspective of controlling costs, an HFCWO device has the potential to pay for itself several times over by helping a patient avoid future diagnostic tests, treatments and hospitalizations that might be required to address recurring respiratory infections, lung damage and other debilitating health effects.
Despite HFCWO’s therapeutic effectiveness and potential cost advantages, insurance payers — both government and private — typically require that at least one other, initially less-expensive therapy be attempted before they will provide reimbursement for HFCWO.
Making the case for HFCWO reimbursement
In general, payers will reimburse for HFCWO when one or more other types of treatment — often a combination of prescription drugs, chest physiotherapy, cough-assist accessories, plus special coughing positions and techniques — fail to provide adequate, consistent bronchial drainage.
Prior to approving an HFCWO device for reimbursement, insurers typically ask the prescribing physician to provide documentation of the patient’s diagnosis and treatment history. If a payer denies coverage, often that decision can be appealed. During appeals, the insurer’s medical director will often consult with the prescribing physician to review the patient’s particular medical need and history before making a final determination of coverage.
Financial concerns? We are here to help.
At Electromed we understand that healthcare can be costly, and many of our patients have mounting medical bills. It is our goal to take the stress off of the patient and work with their insurance provider on their behalf. We never want a financial situation to be a barrier for patients who need SmartVest therapy. Our reimbursement specialists act as an advocate to gain reimbursement from the insurance provider and work diligently with the physician(s) to complete all necessary forms.
If the patient qualifies, to help ease the financial burden, we offer financial assistance programs. We will work with the patient to determine which plan best suits their situation. It is our goal to provide comfortable, convenient airway clearance therapy and improve patient quality of life.
With the only lifetime warranty among leading High Frequency Chest Wall Oscillation devices, Electromed ensures that a patient will have a SmartVest System for as long as it is needed.
As part of its commitment to customer care, Electromed employs a team of experienced reimbursement specialists to handle submission of authorization and prescription forms to insurance providers. Electromed also handles back-and-forth communication with the payer — including during appeals — relieving physicians and their staffs of significant amounts of case documentation and coordination.