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08/31/2012 12:00 PM

Insurance Won't Cover Wheelchair

thiamarie
thiamarie  
Posts: 119
Member

Hi Everybody:

I need some help!

I had been borrowing a lightweight wheelchair with a broken brake from a friend. Then my PMD approved of a standard wheelchair rental which came about 4 weeks ago. I tried using it a few times when necessary, but it was very heavy and was missing the leg/foot supports. I experienced more leg and back pain after using it and lifting it in and out of the car.

I requested a lighter wheelhair with leg supports and my PMD sent in the order to the DME a week ago. When I had not heard from them I called today and they told me that my order was denied and that they were ACTUALLY going to come and pick up my other wheelchair.

I just called my lawyer and he told me NOT to allow anyone to pick up my wheelchair as I need it. I'm SO frustrated!! I don't know what to do...Has ANYONE been through this before??

Thanks, Thiamarie

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08/31/2012 12:44 PM
Fletch2ya
Fletch2ya  
Posts: 3183
VIP Member
I'm an Advocate

HI.... I don't know why they did not approve your wheelchair... I think you should appeal that.... and do it now... I think you will get it overturned.....

Craig


08/31/2012 01:15 PM
thiamarie
thiamarie  
Posts: 119
Member

Dear Craig:

Both my Pain doctor and my Primary Doctor are out of town for at least 1 week. And in that case, the DME will try to get approval OR denial from a covering doctor who would not really know my situation. So at this point, I am not very positive about it. (Just so you know, when I first was diagnosed with RSD, in February, my Podiatry doc's request for a wheelchair was denied after my appealing it two separate times. They based their denial on the basis that I did not require it for "toileting purposes."Wink I am very frustrated about this and this is just "a drop in the bucket" at how poorly my insurance plan has treated me!

Thiamarie

Post edited by: thiamarie, at: 08/31/2012 01:15 PM

Post edited by: thiamarie, at: 08/31/2012 01:19 PM


08/31/2012 05:45 PM
Fletch2ya
Fletch2ya  
Posts: 3183
VIP Member
I'm an Advocate

HI..I don't know what insurance you have..but with my insurance..BCBS, if I dispute something that dispute gets put before a panel and they look over all the facts and then make a decision... if I still want to appeal that decision, I can, and it goes to a higher group of people, who then are doctors... and then they are the final say...... unless I want to get an attorney....

But I can not believe that it is up to just one doctor... Are you under WC??? If so.. you should have an Attorney anyway... and they can get you your wheelchair....

But if not, I would be looking into your policy and reading on the steps if you want to appeal a decision they have made...

Craig


08/31/2012 06:57 PM
maddiesgram
maddiesgram  
Posts: 2330
Senior Member

Thiamarie,

That must be so frustrating. Ugh! I don't have any information or help for you but I sure wish that I did. It's been my desire to get a wheelchair for a couple of years and do things like you've mentioned doing with your family that now are impossible. I want that for you! Just keep fighting. I have to think that the more all of us fight for what we need the more it will help us all in the long run. Good luck with getting exactly what you need! And, come back and tell us what happens.

Don't give up,

gail


08/31/2012 07:08 PM
thiamarie
thiamarie  
Posts: 119
Member

Dear Craig:

The injury was work-related that started the CRPS and my employer a few months ago accepted it as work-related, so you think it would be easy, but It HAS NOT BEEN!Everything from getting: physical therapy, a CRPS diagnosis placed in my medical records, narcotic meds, etc. etc. has been a battle! The appeal process is very frustrating & time-cosuming and it WAS 1 DOCTOR who decided the second appeal to deny me. And now that I have a lawyer it has beeen difficult appealing every single denial that the insurance company has made.

I have been trying so hard to get appropriate treatment that now as I get worse I unfortunately now need to get a wheelchair to get around more. I need less pain and more energy to fight this.

Oh by the way, we have double coverage with the employer health care coverage, so you might realy think that it would be easy to get appropriate care!

Oh well, thiamarie

Post edited by: thiamarie, at: 08/31/2012 07:15 PM

Post edited by: thiamarie, at: 08/31/2012 07:16 PM


08/31/2012 08:49 PM
Fletch2ya
Fletch2ya  
Posts: 3183
VIP Member
I'm an Advocate

HI.. then my other question still is there, do you have an attorney? if not why not...?

They may help you get what you need in a timely fashion....

Craig


08/31/2012 08:52 PM
snoopyemt
 
Posts: 325
Member

She does have one. It just takes forever. Worker's comp is horrible and they take weeks to do anything, but they will take your benefits away in a heartbeat. Good luck Thiamarie!

08/31/2012 08:58 PM
Fletch2ya
Fletch2ya  
Posts: 3183
VIP Member
I'm an Advocate

HI... IN what state? I was under WC when I got hurt.. so I understand.. but they have rules they have to live by also.... And they have to give you services you need, and are not allowed to cause you undo hardship... Your attorney can make that cost them a lot more monies...... And I know most states are the same now in the WC laws....

Craig

Post edited by: Fletch2ya, at: 08/31/2012 09:00 PM


08/31/2012 09:04 PM
thiamarie
thiamarie  
Posts: 119
Member

Dear Craig:

Yes, I am in California. I do have a lawyer, who is supposedly very good.If he wasn't very good I wonder if my claim would even have been accepted.

(I mentioned in my first post that he told me NOT to give the first crappy wheelchair back, since that's all I've got.In my third post, I mentioned that he has appealed every denial since I hired him and it hasn't been easy at all.)

Having a lawyer, I thought would help me to not have to put so much energy into dealing with this medical/legal mess. But I do reaize that without him, I'd truly be in a deeper hole.

I am truly not trying to make money, only trying since the beginning to get medical treatment, which seems to be asking for too much.

Thiamarie

Post edited by: thiamarie, at: 08/31/2012 09:05 PM

Post edited by: thiamarie, at: 08/31/2012 09:13 PM

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