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Thread: Equipment-Medicare-Medicaid-Insurance

  1. #1
    Senior Member Leo's Avatar
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    Equipment-Medicare-Medicaid-Insurance

    I put some thing similar in Funding-Legislation but think maybe this is better.

    A lot of great exercise equipment but it's expensive.

    I'm in the process to see if I can get Medicare to help with the Bioness H200,

    I have evaluation next month and eventually figure I'll get denied but then I can appeal to make the argument to why we need it.

    CMS is the end decider I think and below is my draft to them.

    http://www.cms.hhs.gov/

    CMS about Bioness

    To Whom It May Concern:

    My name is from do to an accident I have been paralyzed from the shoulders down for years. I have been following and advocating for medical research associated with the spinal cord for some years now. I along with thousands of others am very excited to the fact we are now entering into human clinical trials. Geron is one company that is starting this year along with InVivo Therapeutics, Dr. Han’s Kierstead, the North American Spinal Cord Injury Network and Dr. Stephen Davies are some of the others getting ready to start.

    The reason for this letter is to educate and urge you to the reasons why CMS needs to expand the rehabilitative equipment it has approved for Medicare approval and reimbursement.

    For example in my case as a high level quadriplegic who’s first goal is to get return of total arm, hand and finger use. For me the Bioness H200 seems like the best product out there to help me accomplish my goal. The estimated cost saving when this happens is illustrated in the attached document title SCI Costs.

    I am aware that the Bioness H200 is approved for spinal cord injuries under certain criteria that targets acute injuries. However considering the trials that are coming quickly we need to expand that with the view of the longer injured chronic spinal patient in mind.

    As you may know the arms, hands and fingers of a quadriplegics have atrophy and contractions will be a big hurdle to over come that an acute injury does not.
    http://justadollarplease.org/

    2010 SCINet Clinical Trial Support Squad Member

    "You kids and your cures, why back when I was injured they gave us a wheelchair and that's the way it was and we liked it!" Grumpy Old Man

    .."i used to be able to goof around so much because i knew Superman had my back. now all i've got is his example -- and that's gonna have to be enough."

  2. #2
    Leo, is this a draft for the APPEAL, if denied?

    Also, is this an effort to advocate for changing approval/funding guidelines for the Bioness in general, or is this for your individual use and efforts to get authorization?

    I'm assuming this is more about getting personal authorization from CMS. With this in mind, the focus should be on how this equipment will aid in your FUNCTION, and how any gain or improved function will enable greater independence (and consequent reduced care needs = reduced cost). You need to identify SPECIFIC FUNCTIONAL improvements you may gain from this equipment, and how they will impact your independence (identify what they are and what changes are expected/will result. have a ot/pt and Dr. report/verify this).

    Other thoughts in red:
    Quote Originally Posted by Leo View Post
    To Whom It May Concern:

    My name is from do to an accident I have been paralyzed from the shoulders down for years. I have been following and advocating for medical research associated with the spinal cord for some years now. I along with thousands of others am very excited to the fact we are now entering into human clinical trials. Geron is one company that is starting this year along with InVivo Therapeutics, Dr. Han’s Kierstead, the North American Spinal Cord Injury Network and Dr. Stephen Davies are some of the others getting ready to start. I am not sure how relevant this will be, as this doesn't relate to how YOU will benefit from the equipment directly and how this impacts on your current independence/function/health. It may be seen as extraneous info, but may be useful when making an appeal directly to whomever you need to make your case - such as in-person.

    The reason for this letter is to educate and urge you to the reasons why CMS needs to expand the rehabilitative equipment it has approved for Medicare approval and reimbursement. More importantly, relate to YOUR NEEDS.

    For example in my case as a high level quadriplegic who’s first goal is to get return of total arm, hand and finger use. For me the Bioness H200 seems like the best product out there to help me accomplish my goal. Identify a more SPECIFIC and TANGIBLE goal. How will this equipment DIRECTLY effect that goal, and how will that serve and benefit you?

    The estimated cost saving when this happens is illustrated in the attached document title SCI Costs. Is this an itemized list of YOUR care costs, with it showing the potential cost savings you expect from using this equipment?

    I am aware that the Bioness H200 is approved for spinal cord injuries under certain criteria that targets acute injuries. However considering the trials that are coming quickly we need to expand that with the view of the longer injured chronic spinal patient in mind. Can you show how YOUR injury meets those criteria targeting acute injuries? Instead of just stating a need (or an idea) for expanding coverage to chronics, can you show specific reasons why they need to expand, using the benefits to your chronic condition as example? How can this (criteria) target YOUR NEEDS and improve your condition - current and long-term?

    As you may know the arms, hands and fingers of a quadriplegics have atrophy and contractions will be a big hurdle to over come that an acute injury does not. Make statements more assertive and directive. Also, what are those "hurdles" and how will the Bioness equip. positively effect them?
    Last edited by chick; 05-29-2009 at 01:16 PM.

  3. #3
    Senior Member Leo's Avatar
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    Hi Chick, Thanks for the great questions and input. I have some homework now.


    Quote Originally Posted by chick View Post
    Leo, is this a draft for the APPEAL, if denied?

    Not sure yet when and if it will come into play but probably yes, this is new road for me.

    Also, is this an effort to advocate for changing approval/funding guidelines for the Bioness in general, or is this for your individual use and efforts to get authorization?

    Both, because as I see it many could benefit. I need to gather the data and sources that should benefit of regeneration with e-stim.

    The Borgers implant and other studies.

    I'm assuming this is more about getting personal authorization from CMS. With this in mind, the focus should be on how this equipment will aid in your FUNCTION, and how any gain or improved function will enable greater independence (and consequent reduced care needs = reduced cost). You need to identify SPECIFIC FUNCTIONAL improvements you may gain from this equipment, and how they will impact your independence (identify what they are and what changes are expected/will result. have a ot/pt and Dr. report/verify this).

    Other thoughts in red:
    Looking at the C6 level criteria for the www.nascinet.org trial it seems like this device would be very valuable.

    I need to get Wise's 2 cents on that yet.

    Thanks a bunch
    http://justadollarplease.org/

    2010 SCINet Clinical Trial Support Squad Member

    "You kids and your cures, why back when I was injured they gave us a wheelchair and that's the way it was and we liked it!" Grumpy Old Man

    .."i used to be able to goof around so much because i knew Superman had my back. now all i've got is his example -- and that's gonna have to be enough."

  4. #4
    Senior Member Leo's Avatar
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    I got evaluated for the H200 Monday and they worked. Quite the gadget.

    It worked my left hand better than right but that was expected as left has always been more active.

    I had it on left hand for a good 20 minutes and it opened and closed my hand the best it could considering the contractures. It was very cool to watch.

    The OT said I could do that several times a day and not hurt any thing.

    So next move, since it is not covered under Medicare I need to rent it for a 30 trial period at a cost of $500.00.

    They would bill Medicare and I would get denied and then I could appeal and make my case to CMS.

    I wrote to Bioness and got hooked up with someone who gave me some good data to help out.

    500 is a lot for me but i'll probably go for it

    wil keep you posted
    http://justadollarplease.org/

    2010 SCINet Clinical Trial Support Squad Member

    "You kids and your cures, why back when I was injured they gave us a wheelchair and that's the way it was and we liked it!" Grumpy Old Man

    .."i used to be able to goof around so much because i knew Superman had my back. now all i've got is his example -- and that's gonna have to be enough."

  5. #5
    Leo- How is everything working out?

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