Kendall,
I have a very extensive wheelchair evaluation form that I got from a
wheelchair dealer for Medicaid. It goes through medical and functional
reasons for each and every piece of equipment. It ends up being close to 20
pages long. ROM, strength, etc needs are spoken of. Also, for an adult
cardiovascular, prevention of decrease function, improving and maintaining
ROM and strength (all the way through the body), respiratory reasons
(opening of trunk, etc) along with independence, decreased need for
assistance and improved ability to move through environment, configuration
of house and work spaces and need to be able to go up and down stairs (how
many in immediate environment), improve self care skills and ADL and work
load, decreased decubiti and pain management, etc.
Are they giving you an exact reason for denial?
Beth t the ot
> -----Original Message-----
> From: Cerebral Palsy List [mailto:[log in to unmask]]
> On Behalf Of Kendall D. Corbett
> Sent: Tuesday, July 21, 2009 3:42 PM
> To: [log in to unmask]
> Subject: Re: Still Fighting for New Wheelchair
>
> Kat and Peter,
>
> Thanks!
>
> I'm already working on the appeal and the corroborating
> letters of medical necessity. I think if I have to, I might
> even take it to court. I know three other state employees
> who could benefit from chairs of this type, and so it's a
> "systems change" opportunity.
>
> On Tue, Jul 21, 2009 at 1:14 PM, Kathleen
> Salkin<[log in to unmask]> wrot=
> e:
> > Hi, Kendall,
> >
> > I went through the insurance bit with my second cochlear
Are
> implant- the
> > first was a pretty straightfoward approval process but the
> second was
> > a rockier path. =A0I had to have a team of doctors submit medical
> > reasons why it was necessary and had to appeal their initial denial.
> > Fortunately it went through but it was scary there for a
> while, and I
> > thought I was going to be one-sided in my hearing for the
> rest of my
> > life.
> >
> > So don't give up! =A0Appeal!
> >
> > Kat
> >
> > On Tue, Jul 21, 2009 at 2:44 PM, Kendall D.
> > Corbett<[log in to unmask]> wrote:
> >> Anyone out there have any luck getting insurance to
> approve a stander
> >> or a standing wheelchair? =A0About a year ago, I started
> the process
> >> of looking for a new wheelchair. =A0I first tried an IBOT,
> and loved
> >> it, and wasn't able to get insurance to approve it.
> =A0Independence
> >> Technologies then went under at the first of the year, and so I
> >> started looking at other chairs that could do some of what
> the IBOT
> >> did. =A0I tried a Permobil C500 VS, but it was pretty gutless as
> >> configured - wouldn't climb an inch and a half threshold.
> =A0I then
> >> tried a Levo C3, which had good power, good climbing capabilities,
> >> and good options for seating and positioning. =A0Submitted
> it to my
> >> insurance which declined it as not medically necessary,
> although my
> >> doctor wrote an extensive letter outlining the health
> benefits on at
> >> least three fronts that a stander would have, in addition to the
> >> benefits it would have in accomplishing ADL's. =A0Basically the
> >> insurance company is questioning the benefits of standing, or at
> >> least that there are lower cost options out there that
> would do the
> >> same thing,. =A0If I got a static standing frame, It would be more
> >> difficult for me to get into it, and I would therefore use
> it less.
> >> =A0Here are links to the two chairs I've tried, so if
> anyone has any
> >> ideas, I'd appreciate any feedback.
> >>
> >> Peter told me that he/they had had problems with a
> Permobil, which is
> >> part of why I went for a Levo.
> >>
> >> If Ginny Paleg is still around (I remember her from 8-10
> years ago,
> >> and came across a couple of articles she's written on the
> benefits of
> >> standing), I'd really love to hear from her.
> >>
> >> I had my neurologist write the letter of medical necessity, and
> >> wonder if it would be helpful to get corroborating letters from my
> >> primary care doc, my urologist, and other doctors/physical
> >> therapistsd I've seen in the las couple of years. =A0The
> woman at the
> >> insurance company didn't think so, but I think she's got a
> different
> >> corporate agenda, if not a different personal agenda.
> >>
> >> http://levousa.com/c3/c3.html
> >>
> >>
> >> http://www.permobil.com/USA/Products/Rehab/C500-VS-/
> >>
> >> --
> >>
> >>
> >> Kendall
> >>
> >> An unreasonable man (but my wife says that's redundant!)
> >>
> >> The reasonable man adapts himself to the world; the
> unreasonable one
> >> persists in trying to adapt the world to himself. Therefore, all
> >> progress depends on the unreasonable man.
> >>
> >> -George Bernard Shaw 1856-1950
> >>
> >> -----------------------
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> >>
> >
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>
>
>
> --=20
>
>
> Kendall
>
> An unreasonable man (but my wife says that's redundant!)
>
> The reasonable man adapts himself to the world; the
> unreasonable one persists in trying to adapt the world to
> himself. Therefore, all progress depends on the unreasonable man.
>
> -George Bernard Shaw 1856-1950
>
> -----------------------
>
> To change your mail settings or leave the C-PALSY list, go here:
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