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