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Survival Guide for Consumers
Wheelchair procurement (whether buying privately or qualifying for coverage under Medicare or private insurance) is a lengthy and sometimes confusing process. It usually takes several months, even as long as a year. Keep the following tips in mind as you begin this challenging process.
The most important thing you can do is keep a journal! Write down every person's name that you speak to, the company or organization (i.e. doctor's office, supplier, insurance agent), date, and what you were told.
1. Being able to name the person you spoke to and what was said gives you credibility.
2. If someone promises you a special price, recommends a particular chair or function, or if the doctor gives you advice, you need to keep a record to refer to later.
3. Writing thorough notes also lets you keep track of calls and tasks.
Your wheelchair may be delayed for any number of reasons: the prescription is missing information, there's a delay in scheduling a meeting with the seating therapist or supplier, or the insurance company requires more information, such as a letter of medical necessity, or there can be a hold-up by the manufacturer. Expect delays, but don't lose your cool. Instead, be proactive!
Never let your case fall through the cracks. Stay informed about the status of your wheelchair by calling the appropriate member of your mobility team, as needed. Write down the results of all communications (phone calls, written notices, etc.) Your mobility team is: you, your doctor, seating specialist, supplier, and insurer. Stay on everyone's radar screen by following each phase of the process. Make sure each team mate does his/her part (mails prescription, calls the manufacturer, talks with insurer, etc.). You are the Project Manager!
If there's a problem with insurance, ask your doctor or seating professional to write a letter of medical necessity, then makesure the letter gets sent out and received by the insurer. Don't be afraid to keep calling until all problems are resolved. You will get a wheelchair, unless your doctor thinks another type of mobility device is better for you. You may not be the only person who needs one, but your mobility is vitally important!
Denial by an insurance company is common, even typical. If you are denied for a wheelchair, don't be alarmed. First find out the reason for the denial, then ask your doctor or seating professional to advise you on next steps. Your insurer or Medicare may only want further clarification.
If appropriate, your doctor will write an appeal letter to the insurance company for you. Give him or her a couple of weeks to prepare and send it. Then call the doctor's office to make sure it was mailed and/or faxed and the date this was done. You should get a copy mailed to your home. If you don't get a copy, ask your doctor's office to send you one.
Sometimes the doctor asks the seating specialist to write a letter of medical necessity, and then signs off on it. That is because the details of your case are very detailed and must be adequately explained in writing. Since a seating specialist (a physical therapist or occupational therapist who specializes in wheelchair seating and positioning) makes and writes up an assessment for you anyway, it's easier and typical protocol for the specialist to write appeal letters.
Follow the paper trail, stay on top of it, and make sure it's sent out. After a couple more weeks, call the insurance company and ask if a new determination was made, based on the appeal letter. Hopefully, your wheelchair will soon be approved for coverage. (You may also have to make a co-payment or satisfy a deductible.)
Sometimes patients have to appeal several times. Don't waste time worrying about it; just follow through on each and every step, until your chair is approved.
The process is slow and frustrating and that's unfortunate because most people can't afford to wait. But there is fraud in the marketplace, as well as mistakes in seating, so insurance companies must be satisfied that you are receiving the appropriate equipment. In the long run, this benefits all consumers. Try not to get discouraged and take a break when you need one. Make those phone calls in a day or two, when you're alert and refreshed. All your work pays off when your new wheelchair arrives!