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]> wrote:
> Hi, Kendall,
>
> I went through the insurance bit with my second cochlear implant- the
> first was a pretty straightfoward approval process but the second was
> a rockier path. I 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! Appeal!
>
> 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? About a year ago, I started the process of
>> looking for a new wheelchair. I first tried an IBOT, and loved it,
>> and wasn't able to get insurance to approve it. Independence
>> 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. I tried a Permobil C500 VS, but it was pretty gutless as
>> configured - wouldn't climb an inch and a half threshold. I then
>> tried a Levo C3, which had good power, good climbing capabilities, and
>> good options for seating and positioning. Submitted 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. Basically 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,. If I got a static standing frame, It would be more difficult
>> for me to get into it, and I would therefore use it less. Here 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. The 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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>
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>
--
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:
http://listserv.icors.org/SCRIPTS/WA-ICORS.EXE?SUBED1=c-palsy
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