I blanched when I heard that the new version of the power-assist wheels my Adaptive Seating Specialist wanted me to try out sell for $7000.00, bringing the total cost of my chair to $11,000.00.
Long-time wheelers know that this is not out of line, but for a newbie like me, sticker shock set in with the realisation that in the days when I drove, I never owned a car that cost that much.
I was only somewhat mollified when the Seating Specialist added that if she thought that this was impossible to obtain for me courtesy of my insurer, she would say, and additionally, she is familiar with the appeals process. It will be about a month before the manufacturer and their company representative hear anything regarding approval, and everything pertaining to my need has been documented.
I am unsure whether to be happy or keep my head down and prepare for appeals.
I know it's difficult waiting. My insurance (typoed sinsurance, lol) did deny me but they follow the Medicare in-home only rule and I could sometimes walk to the bathroom or short distances without assistance (sometimes not).
ReplyDeleteI would not worry but would cross that bridge when you come to it. While initial denials are common, the appeals process should get you a chair. I was not working with an adaptive seating expert, by the way, but rather my primary care physician and my rheumatologist--in retrospect I should have requested a referral to a seating expert but didn't know about that yet.