Wheelchair Diffusion blog

It seems that fewer and fewer funding sources appreciate the benefits of supplying clients with the right wheelchair.

Right wheelchairs are often selected by a user through clinical evaluation, good advice from peers, personal experience, prior education at the School of Hard Knocks, guidance from a dealer, a proper trial of the wheelchair, or a bit of all of these. You did your homework and you’re ready to rock, but so is the insurance company.

So what can you do when that wheelchair slips through your fingers and you find you have a hand full of denial from your insurer? Lots of things actually- Curse and shout, cry, self inflate and tell the world “I told you they wouldn’t go for it”, or try and do something about it. Let me suggest the last choice. It’s not an easy one and is onsiderably tougher than cursing but it offers the best shot at getting your hands on that right wheelchair.

The following are some strategies for getting another shot at funding that wheelchair or at setting the table for the first shot.

Get the real story on what your insurance actually covers. Not a pamphlet, partial copy, or company flyer.
Winning The Health Insurance Game

Don’t wander off course and get lost in the maze.
Insurance Maze from National Spinal Cord Injury Association

From Infinitec.org some good advice that often goes unheeded:
The most important thing you can do is keep a journal!

A plain language guide to setting the table from the Illinois Assistive Technology Program.
Getting A "Yes" From Your Insurance Company.

Quality not quantity of submissions is a key element.
Appealing A Denied Claim.

A how-to on preparing and submitting a Letter of Medical Neccessity.
Insurance 101 from Fight Spinal Cord Muscular Atrophy.

Some dated but still very valid information from New Mobility.
Jumping Through Hoops With Precision.

Make sure the information you supply your insurer is up to date.
Lorraine Woodward of North Carolina was caught up in this.

Stick with it. These things can take a long time. Be accurate and fire your responses off with precision and accuracy. Get all of your medical justifications in detail. Keep records of everything. Don’t generalize and don’t assume that the reviewers will read between your lines. They will most likely be more interested in their own bottom line.

Watch those sticks! The crew at Wheelchair Hockey League of Michigan are hot on the sport of wheelchair hockey.

In their ninth season, the WHLM brings together people of all ages in a 12 week season of competitive wheelchair hockey that culminates in the Wheeler’s Cup Championship. Hey, move over Mr. Stanley and let some wheelers roll in.

The Wheelchair Hockey League of Michigan (WCHL) was created for the enjoyment of participating in hockey. The purpose of this league is to provide an appropriate means for wheelchair users to have the opportunity to play hockey, and have the chance to engage in the competition and excitement of the sport. The League includes players in powered and manual wheelchairs. The league currently has over 39 players, divided into four teams.

Players range in age from 10 to 60+, and have disabilities that include Muscular Dystrophy, Cerebral Palsy, Spina Bifida and Spinal Cord Injury. Players use a variety of sticks to play, depending on their upper body strength and ability to grip the stick. Some players add on a dowel though the blade of the stick and other players use “Double Sticks”. Double Sticks are two sticks fastened together, with the blades forming a V, and strapped to the player’s legs and chair frame. Games are played 4 on 4, with goalies.

This all sounds like great fun! If you’re into wheelchair hockey or want to get hot on hockey you can check out the Wheelchair Hockey League of Michigan at their website for more information, videos, photos and more.

This was recently handed down from the United States District Court, District of Vermont:

“In a decision on September 24, 2008, the United States District Court, District of Vermont, ruled that the “standing” option of a power wheelchair is not medically necessary and as a result insurance is not required to cover the option (Durgin v. BCBS of Vermont). The case stems from a complaint filed in Vermont by Mr. Richard Durgin who operates a small business. Mr. Durgin’s physician prescribed the standing option as medically necessary.”
Read the entire story.

This has been a longstanding issue. Probably 30 years that I can recall- The need for someone to be able to stand for functional purposes such as reaching and accomplishing certain tasks, and the clinical or therapeutic need to stand.

Many funders have not been keen on combining the two into one package such as a wheelchair with a standing feature onboard since they perceive the standing feature to be a “convenience” and not uniquely dedicated to providing therapy. Or, where does one end and the other begin and which purpose will be the dominant use?

Stationary standing devices that are independent of a wheelchair are much easier to digest as a therapeutic device since they are dedicated to only that purpose and thereby remove the “convenience” cloud. But these may not work well for people who can not access the device alone or who have to stand multiple times per day and are away from the place where the stationary standing device is located.

The fact that the standing feature was prescribed by a physician certainly indicates that there is medical need but its impact may be lessened if no detailed therapy plan was formulated by the doc or by a therapist. You know, how many times per day to stand, how long, goals, indicators, etc. Did the doc prescribe or develop a therapy plan that supports the need for the device? If not, it’s like prescribing medication without prescribing usage and dosage rates. No pharmacy in the world will fill that one and no medication plan will cover it.

This in part may boil down to accommodation as much as convenience. If a person requires standing therapy and they are unable to access the therapy equipment when needed, should they be given the opportunity of having the equipment travel with them? I say yes. If there is a secondary functional benefit such as standing to do tasks, so much the better. That’s getting even more funding bang for the buck.