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Thread: Veteran Adviser Vitaglide rejected

  1. #11
    Quote Originally Posted by Veteran Advisor View Post
    Synbat,

    As long as your treating physician and therapist support this prescription you have the law, or VA directive in this case, on your side.

    In fact, it's touted as a solution for shoulder pain more than anything else. Cardio is just one of the benefits. That PM&R doc could not be more wrong if that was the sole basis of his denial. Read for yourself http://www.grouprmt.com/vitaglide/brochure.pdf

    Keep up the good fight and keep us posted, Synbat
    I would have responded sooner but first I needed to gather all the facts. I contacted my PVA NSO after reading these responses. Yesterday she saw the chief of PT and the chief of PM&R. The chief of PM&R told her that he had every right to deny the equipment because it did not fall underneath cardiovascular rehabilitation. I guess he is a real piece of work (that is an understatement)! The chief of PT -- took my PVA rep off to the side -- told her that the script that was written by my physician needed to say that it was for cardiac reasons. Then I could get the equipment.

    I will say that my physician only wrote up the order in general terms of getting a Vitaglide. However, the physical therapist that evaluated me wrote down half a dozen reasons why. Also, the PVA NSO, informed me that I either need to have the script re-written (cardiac problems) or I would have to be involved in sports recreation. She said those were the two requirements that she did not have to work with. By the way, she used all the information that you gave me. I don't get it!

    I can't help feel that she was rolled over, the PVA rep. Nicest lady in the world but I don't believe that she truly understands how to use her influence to its full capacity. She had to contact a few different people to get these VHA directives exactly straight. No problem there, but I knew a few people she was referring to and they are sharp as a knife. I'm scratching my head wondering why I did not refer to these individuals first -- they are PVA but in different states.

    I am beginning to understand more of the appellate process but I don't think my PVA NOS thinks she has enough to go on. My doctor ordered it, a physical therapist evaluated me and in her opinion thought this piece of physical therapy equipment would be very beneficial. One doctor with the stroke of a pen, in one sentence denied and nullified it. Is this enough to start the appellate process? If so, what will it take for my PVA rep to get this moving. Last week she was fired up and was ready to have VISN become involved. That has all changed now, according to her.

    Thanks for all the advice. I am one not to let things go unless I'm wrong. Veteran Adviser one of the VHA directives she used that you furnished was off by a few digits instead of 1173.06 it is 1173.08. Now that is what she said and as far as I know wrote up. It is the same wording under k. Rehabilitative and/or Recreational Equipment... no big deal. But she had her i's dotted and her t's crossed. What's up? Besides a doctor with a Napoleon complex (PM&R).

    synbat

  2. #12
    Synbat,

    You don't have to "fight" or go through the appeal process for this, in my opinion. Justification is there, just you are barking up the wrong tree with the folks you're dealing with. Again, my opinion. It is the responsibility of the VA to provide justified equipment, such as in this case. You just have to find the person(s) assigned that responsibility. The absolute most direct route I have found is a Physical Therapist at an SCI Center. They are the most likely to have prescribed this for the reasons you need it, and should have no problem pushing it through for you. If they're not agreeable, take your justification on up the chain of command in that SCI Center; make them do their job. Write or fax the Chief of Spinal Cord a complete explanation with justification, and what you plan to do if your needs aren't met i.e.; contact Congresspersons, etc.. A word about that, I wrote and got assistance from my Congressman years ago, yet when I requested help again, I was told by his VA liaison that too many requests lead to being considered "crying wolf", and wouldn't help me a second time. This was years ago, maybe they are more helpful now. But still, I've had much better results dealing directly and entirely with my SCI Center, regarding my SCI related needs, which is what you are asking for. I personally have had better luck going this route than getting PVA, patient advocacy etc. involved; it gets too complicated for them and they tend to go by VA recommendations, rather than learn all the intricacies of the situation and act on that. This is my experience, your mileage may vary. It isn't a matter of luck, it's their job! All the best, keep us posted, others may be having the same problem.

  3. #13
    quadvet,

    There is definitely miles on these wheels. I don't look for any battles or fights but when conflict does arrive, wrong person. This has nothing to do with getting the equipment the easy way, the backdoor or simply going through prosthetics. It has everything to do with a doctor who has screwed with a lot of veterans -- many of which never argue their cases. Now it's just come down to a matter of principle and going through channels.

    Speaking of, in the past I have contacted not just my congressman but also my senators. In fact one senator in particular has helped me in the past. A roommate of mine, from way back when became a Congressman's aid out in Oregon. He was instrumental if I ever had a problem. It's been a little while but this is something actually good.

    Right now I already have a outline draft that will be going to my congressman, my two senators (one who is on the Armed Services Committee), the DOH, to start the list. The letter will contain dates, names and parts of my medical record, for example; the explanation of why it was denied.

    I understand that it would be much easier to go through my spinal cord center that is located in another state but this VAMC is more than equipped to deal with my situation. I found from past experience, sometimes the only way to remedy the situation is to skip the chain of command and start at the top.

    Plus I really would not want to find myself as one of the majority. Take it easy.

  4. #14
    I hear you re: "miles on these wheels", synbat, we've both been at it close to the same amount of time. In fact, a big "thanks" to you for getting after this doctor, I hope it helps lots of veterans by doing so.

    Wish we could have got together when you were out this way, could have done some damage .

    All the best, please let us know when you get your machine.

    By the way, I'm very fond the your Hell On Wheels patch, having worn the Old Ironsides patch for three years back in the day. However, this was my favorite variation of the patch...
    Last edited by quadvet; 11-18-2009 at 05:49 AM.

  5. #15

    Vitaglide Update

    I want to keep Veteran Adviser, KLD and anyone else interested updated on the Vitaglide situation that started earlier this summer. I contacted my PVA NSO and we started a little journey down the road of the VA Clinical Appeals Process. The first thing that I needed to do was to get all of my medical records that were pertinent to the case. Next, I was able to track down the product manager for Vitaglide to see what his thoughts were and what he might be able to do. He in turn, wrote this fabulous letter; simple, to the point and no BS. All of this took approximately 3 1/2 months -- I am referring to the paperwork alone. This week it will be going to the Director of the Hospital.

    The paperwork was laid out in a report fashion: 1) Clinical Appeals Process Letter, Subject -- Denied Exercise Equipment, 2) Reference List, 3) Medical Record Copy -- doctors denial of requested medical equipment, 4) Medical Record Copy -- physical therapists evaluation and recommendation, 5) Letter from Vitaglide's Product Manager, 6) Vitaglide Article -- third-party, 7) Vitaglide Brochure.

    A few comments about the paperwork that was submitted. First of all, the letter that I wrote to appeal the decision was based on fact and no emotion. This is easier said than done especially when you know all of the players. But getting to the point and laying it out cold is the attention grabber. The medical records took a little while to get but persistence pays off. Don't think for a minute they are going to make it easy for you. However, being polite and wearing a smile sometimes can move mountains. Getting a hold of the product manager for Vitaglide and what he was able to help me with will be instrumental. For example, he sent me a great article by Dr. Patrick Jacobs that goes into shoulder pain and how the device alleviates this major problem for people in chairs.

    Last but not least have a little faith and a lot of patience. I know I probably could've gotten this resolved much quicker going through a congressman and senators. The one major reason I chose the avenue of using the appeals process with a PVA NSO was to ensure that my voice was heard. Going through a congressman they may just give you what you want and that is the end of the problem. No messy paperwork just give the man what he wants. The appeals process guarantees that you get a fair chance at making your case. Also, it is supposed to get to the bottom of the problem so this will not happen to you or other vets again.

    During this time I learned a great deal about the appeals process. Also discovered that most of the people that became involved in this either had no idea what was going on or their learning curve was extremely on the slow side. This means do not assume anything. Even my PVA officer had a great deal to learn. And going slow and getting it right is more important than expediency, that is if you have the time.

    One other thing that helped me was documentation. I am not talking about getting copies of my medical records. Instead, I am referring to writing down every important detail that affects me at the VA and my daily life. You need to have dates and names to start with. I can not write with my dexterity so I carry around a little tape recorder. If somebody does not want me to record them, (e.g. a meeting) I will bring a personal assistant to write things down. Many times I'm actually making sure he/she gets the correct information. In some ways that makes you the screenwriter, director and producer all-in-one. This way the only person you have to blame is the one looking back in the mirror at you.

    I hope this helps some veteran that is looking for a recourse when they believe they have not had due process when wronged. Also, once again I would like to thank Veteran Adviser and KLD. I was almost convinced to do it another way but now this gives me the chance to have a peace of mind. I have not won the appeal, in fact the battle has just started now. I am confident of the outcome even if I get turned down the first time. The case will just keep going up a higher ladder. When all is said and done, at the end of the day there will be accountability.

    Synbat

    You can stand me up at the gates of hell but I won't back down.
    Tom Petty

  6. #16
    Wonderful! I am proud of you going through the official process. I hope this gets you what you want and need. I would also recommend that your PVA NSO share this as a case study with the other NSOs when they meet for their annual training. All NSOs should know about this process, as well as this specific piece of equipment and how to help appropriate Veterans get it.

    (KLD)

  7. #17
    Way to go Synbat! It is well worth the effort. The VG is one of the best exercizers I have used. It does wonders for getting in shape and quieting the mind.

    I don't know what I would do with out mine.

    I think the guys down at the Seattle VA was getting them with no problem.

  8. #18
    Quote Originally Posted by synbat View Post
    I hope this helps some veteran that is looking for a recourse when they believe they have not had due process when wronged. Also, once again I would like to thank Veteran Adviser and KLD. I was almost convinced to do it another way but now this gives me the chance to have a peace of mind. I have not won the appeal, in fact the battle has just started now. I am confident of the outcome even if I get turned down the first time. The case will just keep going up a higher ladder. When all is said and done, at the end of the day there will be accountability.

    Synbat

    You can stand me up at the gates of hell but I won't back down.
    Tom Petty
    Synbat,

    The clinical appeals process is so rarely used that many VA personnel and NSOs don't even know about it, which is why I wrote the article some years back. But you're exactly right---you get to be heard. And if it's denied again, you may be able to pursue it even higher so that director will need to seriously consider this. You're a trailblazer, paving the way for other vets in this fight. Thanks for walking the point on this, Synbat. Keep us posted.

    Gunner

  9. #19

    Red face Who's on first?

    Okay, I could write a few pages on what has transpired in the last few months but to the point. On December 11, I received a letter from the Director of the hospital denying the equipment. Yes, this is after sending the whole packet for the appeals process. Then the PVA called and basically said that they messed up. I was not supposed to send the reconsideration to the Director of the hospital but to the Chief of Staff. They discovered their mistake by going to the Patient Advocate of the hospital who explained that the Chief of Staff handles this.

    Is anyone reading this getting as confused as I already am? So I'm not going to write a new letter but just forward the old one to the attention of the Chief of Staff. Also, I will add the names to the people that I request to be at a hearing. Important to note, I was notified that if I wanted someone at this meeting I had to put his or her name down. This included any personal advocate, such as a PVA NSO.

    Just wanted to keep everyone up to date. This by no means is a quick process and half the time you feel like a ping-pong ball. One thing I cannot emphasize enough is that my PVA reps and the hospital personnel are not only reluctant to use this method -- to be nice -- but are ignorant about the procedures.

    All I can say is now it is up to the Chief. This is starting to get good. And by the way, who ever wrote the letter for the director of the hospital has no clue of what is going on. In fact, if anything this letter reinforces my case by reiterating, "VA Ann Arbor's policy on exercise equipment is to limit purchases to patients within a defined cardiac rehabilitation program. The only exercise equipment we provide for spinal cord injury patients is a sports wheelchair." I love that last sentence. I wonder how I ended up with my standing frame acquired from this same VA.

    On Wednesday my new letter will be going out to the Chief of Staff and within a few weeks they must reply or so I'm told. I will keep this updated but I am dealing with red tape bureaucracy--it can get deep. Happy new year!

    synbat

  10. #20
    Hey Synbat, Happy New Year to you!
    Sorry I missed this, wanted to see how you were coming along here. Yep, not the first time I've heard of a veterans service organization messing up. Some say they work for the VA, but you didn't hear me say that. Also heard patient advocacy referred to as the "short circuit" between patient and higher.

    So will you get to go to the hearing? Sure would be nice to know what goes down on your behalf, seems like it should be a right. Well keep us posted, and remain vigilant .

    All the best.

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