K needs high flow oxygen via non-rebreather mask for his cluster headaches. This is the gold standard of treatment, it is incredibly low-risk, effective in 70-80% of patients, and accepted as the first-line option by every major medical organisation related to neurology and headache. It is as basic and necessary as insulin for diabetics or inhalers for asthmatics.

Kaiser won’t cover it. Because our insurance does not have a durable medical equipment supplement. Because we cannot get a durable medical equipment supplement. We have the highest tier plan, pay $1400 a month each for this insurance, but the durable medical equipment supplement is only offered on group plans. If you are a freelancer, a sole proprietor, or in any other way not employed by a business with at least 5 employees on the same insurance plan, you cannot pay for durable medical equipment coverage.

It’s worth noting that he had durable medical equipment coverage with his last employer–when he was on a lower tier plan. We are paying more for less coverage. Simply because he is self-employed.

So we are now looking at dropping to a lower tier plan next year in order to offset the costs of having to pay for his medically necessary oxygen and therapy entirely out of pocket. Because we literally have no option to pay for the supplemental benefit that would cover it.