It’s hard to believe that it’s only the middle of February and with the state of affairs in the world today I try very hard to focus my energy on affecting change in whatever capacity I am able to in order to bring a little bit of light into this world. I’ve said this time and time again, but kindness, positivity, and perseverance go a long way in my book.
I would be a hypocrite if I didn’t attempt to put actions to my words. So, I have made quick work of focusing on two new Blue Cross and Blue Shield cases, which I believe are so important for so many who are disabled.
My overarching mission in these constant insurance battles is not to just simply win “stuff” from insurance companies, but rather to strategically attain medically necessary durable medical equipment that not only improves the quality of so many people’s lives, including my own, but our independence and dignity.
The challenge lies in that many of our health insurance policies are simply outdated and many of them do not factor in the special needs for those who are severely disabled. With that said, it is my goal to create a host of documents with letters of medical necessity written, so patients can just hand them to their doctors and fill in the necessary personal information.
I’m working to change the system from the inside out, but in the meantime many of us really need to learn how to operate and navigate within the broken system we are currently faced with. It’s not easy and most people don’t have the time, energy, or know-how to get things accomplished. Unfortunately, many people just take their insurance policy at its word and don’t test the system.
Change does not come from blind compliance!
We have to push the boundaries because we are, the disabled community, a very much forgotten about segment of the population in the eyes of health insurance policies.
With that said, I’m working with multiple nonprofits around the country to host a website on how to navigate the appeal system within your health insurance company –call it “patient-to-patient” guide if you will.
Honestly, it can be tireless and thankless work at times, but I truly believe someone has to do it, and this is just my part in paying it forward in the world.
Without further ado, these are the two major cases I am presently working on:
Case #1 – VitaGlide – Adaptive Rowing Machine for Cardio Respiratory Exercise
This case is really my baby. The VitaGlide (www.vitaglide.com) is an adapted piece of exercise equipment that creates a rowing like motion for cardio exercise. It’s unique as compared to standard stationary hand cycles because it does not injure your rotator cuffs because it utilizes all of the back muscles. Unfortunately, pushing a manual chair or transferring into and out of wheelchairs & beds creates serious shoulder injuries for the user.
The giant hurdle am running into is that physical exercise equipment under my health insurance plan, and most plans for that matter, are considered a “Non-Covered” Benefit because they are categorized as convenience items. Therefore, you get denied before you even start because most insurance plans will not review your case under medical necessity. This actually happened to me this past fall. However, when I won my seat elevator in March of 2020, the seat elevator was also considered a convenience item and was therefore not covered by my policy, but they made an exception in my particular case.
I am not looking for health insurance companies to create a blanket policy to approve all non-covered items, but in very specific cases and based on a patient’s diagnoses, I wholeheartedly believe insurance companies need to make exceptions if one can prove the medical necessity of a piece of equipment or service. I’m only looking for a fair shot for insurance to view the VitaGlide as medically necessary in my particular case or for those in my situation as well. They did it for the seat elevator, why can’t they do it for the VitaGlide too?
So, after I was denied this past fall I decided to flip the case on its head and start over. I reviewed over 130 peer-reviewed journals trying to prove the medical necessity of physical exercise for spinal cord injury patients. I worked tirelessly on this case day and night for months. I’ve had it reviewed by several lawyers, physical therapists, exercise scientists, and a health insurance consultant.
I’ve attached my final work product and I will keep you updated if it is successful or not:
Even if I’m denied, I’m going to use this paper as a platform to change policy with my elected officials, the media, and whoever else will listen to my plea for help.
Case # 2 – High Low Bed Frame
The second case I’m working on is for a high low bed frame. Essentially the bedframe can go up and down in order to offer same height transfers for safety for people who are in wheelchairs. In addition, the bedframe also offers the patient the ability to put their head and feet up and down on the bed, which provides a whole host of solutions to choking, weight shifting, turning, etc.
Last year I successfully managed to have my insurance company pay for a special pressure relieving mattress, which is excellent. However, being paralyzed from the chest down and lying flat all the time can be very dangerous for me, so the bedframe is another critical component.
I’ve written this letter of medical necessity for the bedframe and I submit in the next several weeks to insurance in February 2021. I will keep you updated on my progress to see if they approve it, deny it, or if I will have to appeal it. Either way I will not give up on this either.
The one thing I have going for me is that there is a specific medical code attached to bedframe’s, which makes things a little bit easier in the sense that I just have to prove the medical necessity of this particular piece of equipment. It’s much more challenging if you’re trying to have a non-covered benefit approved such as with the VitaGlide.
However, this does not stop insurance companies from denying you anyway even with a medical code. You still have to fight for your right to survive and with a very convincing argument I might add.
In conclusion, I’ll leave you with this thought. Not everyone has the ability for number of reasons to be their own self advocates. Many of us need help. I try to encourage being your own self advocate, but with a helping and guiding hand from people like myself, and people that are far more knowledgeable than I am.
I always admit when I don’t know what I don’t know, but I then find smarter people around me who can help nudge me in the right direction. I just ask a lot of questions. The trick is, you just have to ask for it and follow through on the help given. I can help in so many ways and will, but you also have to be willing to do your part. This has to be a collaborative group effort – anything that is worth fighting for does!
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