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.