Six months after the Federal Aviation Administration changed its rules to make air travel easier for people with emphysema and other respiratory illnesses, the two breathing aids approved for travelers' use on commercial flights are proving too expensive for most patients.
And it gets worse.
Airlines have established a hodgepodge of conflicting policies, and some airport security screeners seem unaware of the new rules.
The result: "It's made no difference," said Dr. Richard Pomerantz, a Palm Beach Gardens pulmonary specialist who has been an outspoken advocate for people with respiratory diseases.
"The airlines accommodate other people, but they don't accommodate people who require oxygen, and I find that just incredibly unfair," he said.
Until Aug. 11, travelers who needed supplemental oxygen when flying often spent more time and money in planning their flights than they did in the air. Compressed oxygen had to be bought from individual airlines, which charged $100 or more for each leg of a trip. Flying round-trip from West Palm Beach to New York City with a stopover in Atlanta, for example, could add $400 to the cost.
In addition, a 48-hour notice was required to reserve the oxygen, and a doctor's letter was needed each time a patient traveled.
If the flight had, say, a two-hour layover in Atlanta, more oxygen had to be ordered from a local company so the passenger could breathe before boarding a plane for the second leg of the journey, when the airline again would provide oxygen.
Last summer, after more than a year of discussion, the FAA approved two breathing aids, called "portable oxygen concentrators," for use on all commercial flights. Unlike compressed oxygen, which is classified as a hazardous material, both the AirSep and Inogen One brand concentrators separate the oxygen from nitrogen and other gases in the regular cabin air and filter it to the patient at a purity rate of about 90 percent.
Passengers simply could buy a concentrator, which weighs about 10 pounds, and use it whenever they flew. And a one-time doctor's note would be sufficient.
But the well-intentioned rules change is encountering some turbulence.
The AirSep has a list price of about $4,000, and the Inogen One costs about $5,000.
"So it's meaningless to the average person, unless you're a very wealthy individual," said Harold Sagalow, 76, a Boynton Beach retiree who has used compressed oxygen since being diagnosed with emphysema in 1990. "It amounts to a toy, and you've got to be a very, very wealthy person to afford this toy."
Both units plug in and also can run on rechargeable batteries, which cost about $150 to $200 each. But the batteries last only about two hours before needing to be recharged, so a traveler on a six-hour flight might need to bring at least two along if the airline cannot or will not provide an electric power source.
"Most people can't afford it," agreed Greg Esposito of Cardiosom of Palm Beach, a respiratory and medical equipment company. "We're getting a lot of questions because people have heard about them and think, 'I've got Medicare.' "
But Medicare allows only about $200 a month to supply oxygen, and at $4,000 or more each, it wouldn't be feasible for his company to rent them.
"Medicare won't buy them," Esposito said, "or everybody would have one."
For those who can afford their own oxygen concentrators, the next hassle arises from the airlines' conflicting policies.
In dropping its objection to portable concentrators on board flights, the FAA nevertheless left it up to individual airlines. Some allow the AirSep but not the Inogen One. Some allow both. And some, such as American Airlines, forbid both and still require passengers to buy oxygen from them.
Most frustrating, though, is what can happen after you've paid $4,000, bought an extra battery, found an airline that accepts your model and arrived at the airport.
Portable oxygen concentrators are small, portable devices that separate oxygen from nitrogen and other gases in the air and provide oxygen to users at greater than 90 percent concentration.
The two devices, manufactured by AirSep Corporation and Inogen, Inc., do not use compressed oxygen, which the government classifies as a hazardous material. They work by filtering nitrogen from the...
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Major airlines provide oxygen but typically charge $75 to $100 for each leg of a flight. That increases the cost of a direct round-trip ticket by as much as $200.