Health Insurance Coverage for NTM Treatment

Patients who are diagnosed with nontuberculous mycobacteria (NTM) often need assistance in determining which treatments and health services are covered by their health insurance — and, if covered, to what extent, said Toni Kuper, RN. Toni assists National Jewish patients with problems and questions regarding insurance. Coverage must be determined for in-hospital treatment and services, as well as for outpatient treatment and services, home-care treatment and services, or treatment and services in an extended-care facility, nursing home or hospice.

NTM patients are often discharged from hospital treatment and sent home for continuation of antibiotic therapy. The questions regarding insurance coverage can be thorny — for example, does insurance cover (1) all or a part of the cost of home-administered antibiotics, (2) visits of a nurse who administers antibiotics or teaches the patient how to administer the drug and keep IV lines clean, and (3) nurse follow-up visits to inspect and replace IV lines or other equipment, or to place a new IV line?

If the patient is given a prescription for home oxygen, will there be insurance coverage for durable medical equipment(e.g., oxygen tanks and refills) and for therapist or technician visits?

Because Medicare coverage can vary for medical equipment between four different Medicare regions in the United States, and for coverage of medical/hospital care between 12 Medicare regions, the patient may find it difficult to sort out what medications and services are covered by Medicare. Some patients carry a Medigap policy that will pay all or a portion of the difference after Medicare pays its share — typically 80 percent of Medicare-allowable charges.

Institutions that specialize in treatment of NTM disease — such as National Jewish Medical and Research Center — have consultants on staff who work with the institution’s patients to obtain the maximum allowable insurance coverage and can help communicate for patients.

 

Learn more about nontuberculous mycobacteria (NTM).

Learn more about NTM treatment at National Jewish Health.

 

This information has been approved by Toni Kuper, RN , (January 2008).