Mom's clearly exhibiting hypoxia, but Doc is denying due to 95 "Pulse oximetry" test . How can we get around this? -- Her "normal" 02 levels are probably *way* lower than when she had to move, walk, stand -- to get to doctor's office. Also, these probably fluctuate, much like "blood sugar" levels for a diabetic patient. Yet without doctor's clearance, we can't get Medicare (or private supplemental insurance) to pay. What can we do?

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She may feeling short of breath b/c she is anxious and then the anxiety causes even shallower breahting and an increased feeling of shortness of breath. If she can slow down and take some full breaths, hold them a bit, and repeat, it might decrease her feeling of hypoxia. Taking deep breaths is not a magic fix, but it's worth trying.
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Reply to RedVanAnnie

GenkiGuy: "Does Medicare pay for oxygen equipment?

covers the rental of oxygen equipment and accessories as durable medical equipment (DME) that your doctor prescribes for use in your home. If you own your own equipment, Medicare will help pay for oxygen, contents and supplies for the delivery of oxygen when all of these conditions are met: Your doctor says you aren't getting enough oxygen."
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Reply to Llamalover47

We haven’t heard again from the OP, many excellent replies, but I’ll just add two things:

1- If what you mean is that your mom seems short of breath, or complains of shortness of breath, or is breathing heavily with exertion: there are actually many things that can cause that besides actual low oxygen levels (congestive heart failure, heart disease/angina, anemia), I’d make sure all these are thought about before thinking about oxygen – honestly with the resting oxygen saturation 95% just going straight to oxygen therapy wouldn’t be the first thought.

2-To actually answer your question though, as other posters have said, Medicare has cut offs. Below is a link to the different ways that Medicare will consider it qualified. It usually boils down to : A documented oxygen saturation of 88% or lower at rest (#1) or at least with activity (point 4).

If you think the issues are mostly with activity, a walking oxygen saturation at docs office would be helpful.,An%20arterial%20PO2%20at%20or%20below%2055%20mm%20Hg%20or,the%20day%20while%20at%20rest.
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Reply to Rumbletown

I am not sure if this helps but my mother was prescribed oxygen at night due to sleep apnea. This was covered by Medicare.
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Reply to liz1906

My mum has COPD, and her O2 readings are usually within the norm for her condition - between 88 and 92. They sometimes fall when she needs to exert herself - walking a short distance (living room to bathroom) and getting dressed, with assistance. However, they usually go back up to the level that's normal for her within a short time.

Despite my mum often feeling that she can't breathe and getting out of puff, she has never been given oxygen at home, and her doctor says that it wouldn't be viable, even if she gave up smoking.

My mum is given an inhaler to open up her airways when she is really struggling. The main thing that helps, though, is calming her down.
When we feel we can't breathe, we get panicked and hyperventilate, which makes the situation worse. I suspect this could be what your mum is experiencing.

Your mum doesn't need to be exerting herself too much at her time of life and in her condition. It would be good if she could learn both breathing and calming techniques.
There are exercises that could help your mum fill her lungs better when she breathes. Even my mum, with a known reduced lung capacity and dementia, was expected to practice breathing exercises after she had aspiration pneumonia.

I hope that your mum starts to feel better soon.
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Reply to MiaMoor

Patients qualify for home O2 if they have a Sat 88% or lower for at least 5 minutes. This is tested by a qualified provider at rest and with activity. Insurance will not pay for it otherwise. Doctors need this test. Your question and my response to you actually can be on a registry exam for respiratory therapy graduates to pass their registry exams. When equipment is ordered and insurance pays, the patient is pretty much hampered by the fact that it comes from an oxygen concentrator and a lot of hose. They may only get a couple of tanks that last a couple of hours each month. These tanks are for traveling to the doctor. There is not enough supply to take the person out shopping for the day. If you see those tanks that people carry over their shoulder, they pay a few thousand of their own money.

To clarify your statement about hypoxemia with no qualifications due to Sats, the person my actually be experiencing dyspnea or observed shortness of breath. The reasons depend on many factors of chronic lung disease, fluid retention and cardiac factors. The person needs to work with a pulmonologist to see if medications and lifestyle changes can make the person feel better.
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Reply to MACinCT

Why do you say she is "clearly" having hypoxia?
What proof do you have of this condition?
Is she perhaps only hyperventilating?

Keep a diary of pulse oximetry measurement (cheap on amazon, that little gadget) and activity that changes the readings.
If you present this to the doctor more testing may be done.
But a scan that shows good lungs, a listening to the lungs by the MD, and a good pulse ox in the office with clear lungs is going to be HARD if not impossible to get around.
Fact is fact.
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Reply to AlvaDeer

You can request an ABG or Arterial Blood Gas test for mom. Blood oxygen levels refer to the amount of oxygen circulating in the blood. Pulse oximitry tests can be thrown off by sunlight, nail polish and skin tones. Here is a link to an article explaining ABG tests in detail:

I've had many of these tests OUTSIDE of a hospital setting, although the article states it must take place in a hospital. It does hurt though, but nothing horrible. Idk that the doc will agree to such a test....but it's worth a try.

Also buy yourself a pulse oximiter at the drugstore and test mom after she walks around and exerts herself. Keep notes and a chart of symptoms for the doc.

Good luck.
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Reply to lealonnie1
Sohenc May 19, 2024
Yes, get the arterial blood gas labs done AND get with a pulmonologist for a "lung function test." She may need both Xray and other imaging (CT) of the lungs. Blood work too as others have said, too few red blood cells/too immature red blood cells (?) may NOT be carrying enough oxygen to organs. And yes, other conditions as others have said "cognitive heart failure." So the too needs to be run to ground.
Pay for what, oxygen? Her pause ox level is 95 which seems to mean she is getting emough oxygen. I read this article and seems to me that pause ox levels have something to do with hypoxia. I am not a nurse.

"Oxygen saturation is an essential element of patient care. Oxygen is tightly regulated within the body because hypoxemia can lead to many acute adverse effects on individual organ systems. These include the brain, heart, and kidneys. Oxygen saturation is a measure of how much hemoglobin is currently bound to oxygen compared to how much hemoglobin remains unbound. At the molecular level, hemoglobin consists of four globular protein subunits. Each subunit is associated with a heme group. Each molecule of hemoglobin subsequently has four heme-binding sites readily available to bind oxygen. Therefore, during the transport of oxygen in the blood, hemoglobin is capable of carrying up to four oxygen molecules. Due to the critical nature of tissue oxygen consumption in the body, it is essential to be able to monitor current oxygen saturation. A pulse oximeter can measure oxygen saturation. It is a noninvasive device placed over a person's finger. It measures light wavelengths to determine the ratio of the current levels of oxygenated hemoglobin to deoxygenated hemoglobin. The use of pulse oximetry has become a standard of care in medicine. It is often regarded as a fifth vital sign. As such, medical practitioners must be familiar with the functions and limitations of pulse oximetry. They should also have a basic knowledge of oxygen saturation."
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Reply to JoAnn29

What signs of hypoxia is your mom exhibiting? I’m assuming you’re wanting to get oxygen for her. Medicare has specific guidelines and I’ve never heard of anyone qualifying with a pulse oxymetry reading of 95%, typically needs to be below 88%. Sorry if I’m misunderstanding your question—if she ever appears to be in severe respiratory distress, I would always recommend evaluation in an emergency room.
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Reply to MidwestOT

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