Due to the frequent rejection of claims for noninvasive ventilators by Medicare Advantage plans, individuals with amyotrophic lateral sclerosis (ALS) are experiencing disproportionately high rates of hospital admissions.
Due to the frequent rejection of claims for noninvasive ventilators (NIVs) by Medicare Advantage plans, individuals with amyotrophic lateral sclerosis (ALS) are experiencing disproportionately high rates of hospital admissions for inpatient care. Jeffrey Sippel, MD, MPH, associate director of inpatient clinical services and associate professor of clinical medicine in the Pulmonary Sciences & Critical Care Medicine Division at the University of Colorado School of Medicine, highlighted this issue in an interview with the American Journal of Managed CareⓇ (AJMCⓇ).
What has been the impact of these denials on patients with ALS and their families, considering the urgency of their medical needs?
I think the impact of this type of approach from the insurance companies, I think it's had a huge impact on our patients and the families. What we like to do is provide relatively seamless care for these very, very complex patients. Here's how I would define seamless care: Three to 5 to 6 years ago, if we had a patient who had imminent need for support, we could actually get it arranged within 24 hours. There are even times where we saw a patient on Friday and had support arranged for them at home by Saturday. That is super cool, and it is super good.
And so when you have that as what's achievable, and what's doable, and then you fall back to having to wait days to weeks or longer, secondary to denials and appeals, then the most important thing is that it delays life-saving care for these patients, number 1. Number 2, we sometimes have to admit them to the hospital, which is a big wildcard and it's a big disruption for them. And then number 3, the family and the support. They want these patients at home, they want to love the heck out of them. And when there are delays in care and they watch their loved one going downhill without support or have to get admitted to the hospital, that's just a really complicated thing. Unfortunately, a lose-lose is really what it's been on this.