Tuesday, November 18, 2014

When the insurance authorization letter arrives....

We received the insurance authorization letter we have been waiting for since last month.  It’s always an interesting piece of mail to receive because we just never know what the answer will be.  Will they authorize needed equipment or will they deem that it is medically unnecessary? What seems obvious to us as something that should be approved isn’t always approved.

For example:  When S was 8, he needed a new walker.  Obviously, that should be approved. He couldn’t walk without it.  We also asked for a basket for his walker since he can’t carry anything because both of his hands are on the walker that he needs for walking.  The basket was denied because it was considered to be a luxury item.  Really?  I think if you are a child who requires a walker to walk then you should be allowed to have darn near anything on your walker without anyone saying you are in possession of a luxury.  We filed an appeal.  They wrote back.  Back and forth we went for a couple of months.  The decision was finally reversed; however, the amount of money that they spent in personnel time and paperwork cost more than the “luxury” basket for the walker.

S’s current wheelchair has light up front wheels.  We knew they wouldn’t be approved.  I will agree that they are a “luxury”.  The insurance company’s take is there are already front wheels that come with the chair.  Yeah, but if you need a pediatric ride, let’s have fun with it.  Anyway, we paid for those.  [He gets a lot of comments on his wheels.]

This brings us to the present.  S currently has a manual chair that he uses for longer distances: the airport, amusement parks, the mall, etc.  Last month we met with the Pediatric Physical Therapist and our Seating and Mobility Specialist to discuss S’s mode of transportation at college:  manual vs. power.  S has NO desire to have a power chair.  Doesn’t even want to discuss it.  His responses are:  “I am fine without it.”  “I don’t need it.”  

The reality is that he is going to have a hard time getting around a college campus with a manual chair.  We, along with other respected adults in his life, have tried explaining to him that he can expend his energy pushing himself around campus OR he can expend his energy studying and learning. As the PT clarified for him, “Your parents are not going to be there to push you around.” The Seating and Mobility Specialist uses a wheelchair and explained to S that different places call for different chairs and college is a place that he will want something else.

As we sat there and discussed different options -  power chair, power assist rims, manual chairs - the Seating and Mobility Specialist said, “S, come here and look at this video.”  S watched the video, and the decision was made.  He wanted this device, the SmartDrive.  

How cool is this?  S agreed that this was definitely something he would accept for his mobility needs.  The next step was getting insurance to authorize it.  That’s the letter we received today. They authorized it along with some replacement parts for his chair.  Wise choice on their part because it is cheaper than a new power chair.

There was something they denied.  S was ready to battle it out.  I told him sometimes you have to pick your battles.  We wanted a mesh catch-all net for under his chair since it is difficult for him to turn around to get things out of a backpack on the back of his chair.  However, this isn’t a battle worth fighting.  We have the authorization for the big ticket item.  I think we can private pay for the net.

This is worth celebrating.  You will find me on the couch with chocolate!

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