My SmartVest was prescribed by my bronchiectasis/ MAC clinic, it was paid for by my Medicare advantage plan except for a ridiculous copay which was covered by the company's financial assistance. I had no wrinkles with getting it covered but some people have trouble. I think it helps to have it prescribed by an office that has a lot of experience prescribing them because they will know what qualifies you and what is more likely to trigger a "no" (which then can be appealed).