It's hard to imagine anything more essential to life than the ability to breathe. Yet Medicare Advantage plans are denying hundreds of claims for ventilators to patients with amyotrophic lateral sclerosis, or ALS, as not "medically necessary."
Often referred to as Lou Gehrig's disease, ALS is an incurable disease that progressively weakens the muscles, robbing patients of voluntary movements like walking or talking. As the disease advances, many patients need a ventilator to breathe.
If a person living with ALS has traditional Medicare, they''ll almost certainly have no problem getting her claim for a ventilator covered. But if they have a privately administered Medicare Advantage plan -- like nearly half of all Medicare beneficiaries -- their claim will probably be denied.
