Hello,
I as a PT had to appeal a w/c for a gentleman with quadriparetic athetoid CP
with severe muscle contractures who was in his late 60's. Their questions
which I had to answer for him during his appeal to get his power w/c were
interesting. They were:
1. Doesn't a person grow out of CP? Why hasn't he grown out of this
disability yet?
2. Why does he need a power w/c can't a manual w/c? Why wouldn't a manual
w/c be sufficient?
3. Does he still work?
4. Why does he need a custom seat (contour) with a tilt in space system?
All of these questions were answered in the LMN. However, it the letter was
over ten pages single spaced. Although I must admit I did not say CP was a
lifelong health condition because I thought that was known.
Good luck,
Greta
On Thu, Jul 23, 2009 at 3:42 PM, ehthiers <[log in to unmask]> wrote:
> 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
> > >>
> > >> -----------------------
> > >>
> > >> To change your mail settings or leave the C-PALSY list, go here:
> > >>
> > >> http://listserv.icors.org/SCRIPTS/WA-ICORS.EXE?SUBED1=3Dc-palsy
> > >>
> > >
> > > -----------------------
> > >
> > > To change your mail settings or leave the C-PALSY list, go here:
> > >
> > > http://listserv.icors.org/SCRIPTS/WA-ICORS.EXE?SUBED1=3Dc-palsy
> > >
> >
> >
> >
> > --=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:
> >
> > http://listserv.icors.org/SCRIPTS/WA-ICORS.EXE?SUBED1=3Dc-palsy
>
> -----------------------
>
> To change your mail settings or leave the C-PALSY list, go here:
>
> http://listserv.icors.org/SCRIPTS/WA-ICORS.EXE?SUBED1=c-palsy
>
-----------------------
To change your mail settings or leave the C-PALSY list, go here:
http://listserv.icors.org/SCRIPTS/WA-ICORS.EXE?SUBED1=c-palsy
|
