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Thread: FES Bike and Insurance

  1. #1

    FES Bike and Insurance

    I've been trying to get an RT-300 FES bike for nine months and was finally denied by my insurance company - Blue Cross Blue Shield of Massachusetts. Has anyone gotten an FES bike approved by any Blue Cross? Has anyone successfully contested a denial?

  2. #2

    FES Insurance

    we tried and were denied early on...knowing what I know now I would have appealed until we received positive results. Since then everything we have appealed more than once we have received...
    PEACE

  3. #3

    Smile

    We have appealed and been denied several times. We have the same insurance as you, California though, and they won't budge on their decision. We'll keep trying until they get sick of us and will just approve it rather than hearing from us again. I will wear them down!

  4. #4
    Thanks for the feedback. I got an update - the bike was originally denied because it was too expensive. It really seemed like my insurance company didn't know what it was. BCBS is going to send a letter to RTI basically asking what the FES bike is / does. They will re-evaluate after receiving a response.

  5. #5
    Way to Go East. You have to be persistent with insurance companies. I can assure you that a FES bike is way beneficial. They shuld also be looking at getting you a stander and an extra chair. don't back down, this is not something frivolous. The beneifits of FES ie outstanding.

  6. #6
    I tried one last summer in rehab - it was awesome and I can't wait to get my own. I'm pretty sure I can make a good business case for the insurance company if they deny it again. I've got papers lined up showing not only that it improves circulation, decreasing risk of pressure sores, improves heart function, improves bone density, decreasing risk of bone fracture, and improves glucose levels and insulin tolerance, decreasing risk of diabetes, but also how much each of those conditions would cost.
    I've had a standing frame (EasyGlide 6000, which is great and I use it nearly every day) and an extra chair (Quickie Ti, which I think would be great if it were an inch narrower and the foot rest extended an inch farther) for several years. If I get this, all I need is a FreeWheel!

  7. #7
    Senior Member
    Join Date
    Jun 2002
    Location
    Huntington, NY
    Posts
    130
    My insurance company covered my ERGYS FES bicycle way back in 1986. Back then, the bike was new technology and it took me over a year to get coverage for it. The price of the bicycle at that time was I think 18,000 or 30,000 but either way my insurance company covered in full the cost. I will explain to you how I was able to achieve that result.

    First of all you need a doctor's letter, preferably a physiatrist who knows your physical situation very well and who perhaps has been monitoring your case for more than a year. I'm fortunate in that I have had the same doctor since I first was injured (C4/C5 complete) over 30 years ago. Back in 1985 I had only been hurt eight years and so having one doctor over the entire period he was able to write a pretty persuasive case for the bicycle.

    Persistence is essential in getting anything above a crutch covered by a private insurance company. You must appeal and you must keep on appealing until you get what you want. Each time you appeal, add a new reason in support of your case. I cannot stress that enough. I know appealing over and over again can be stressful. The insurance company knows the same thing. I can tell you personally that the horror stories you hear are true. Insurance companies count on the laws of attrition: only a few people out of every hundred will appeal and of those who appeal only a few of those will keep on appealing until they achieve success. That is a fact; accept it and deal with it as it is or do not even engage them. Some insurance companies have been in business for over a hundred years, they know human nature very well and they use their knowledge to dissuade people from filing claims.

    Finally, let me tell you how much the ERGYS has helped me over 30 years. I am very diligent about my skin care as well as every other aspect of my spinal cord injury care. As I say "I take my care seriously, but I'm not serious about my care" that means I liked kidding around and keeping a light atmosphere but when it comes to my skin care done properly I am dead on serious. I say all that first because the ERGYS has helped me maintain my skin integrity and fight off skin ulcers that probably would have killed me years ago was it not for the bicycle.

    My urinary output increases every time I ride and therefore it helped me fight off potential bladder infections which of course could turn into kidney infections.

    Cardiovascular issues are well known with cervical injury spinal cord patients. Aerobic exercise must be done to achieve any type of cardiovascular results with cervical injuries. It is generally difficult to raise the heart rate of cervical injury quad to a high enough level to achieve cardiac benefits. That being said, one can understand how an arm crank ergometer may provide a slight benefit cardio wise to a cervical injury quad but it is much more likely and I believe it has been proven in medical journals that much better cardiovascular results are achieved in cervical injuries through bilateral leg ergometery then through any type of arm crank.

    Posture. Since the gluteus muscles are one of the three groups of muscles utilized by the bicycle, you can imagine that after using it for a while your posture will improve. That is a help in preventing a whole host of orthopedic problems that may set in after many years of sitting in the chair.

    Pelvic floor muscles. Most complete quadriplegics have a neurogenic bowel that requires some type of assistance in order to achieve a bowel movement. In my personal experience, having a strong pelvic muscle and generally strong gluteus' as well as a well functioning anal sphincter all help in making my bowel function as efficient as possible. Have you ever heard of a prolapse rectum? They require surgery sometimes and are generally a nightmare which can be caused by weak pelvic floor muscles.

    Oh, one more thing. Another has been great debate in this group about the benefits of using a standing frame regularly. In my personal experience, I ride the bike every other evening and on evenings that I'm not riding the bike, I stand in my standing frame for two hours at 60°. Obviously some nights I have trouble maintaining blood pressure and I must go down earlier in time and or at a lower angle. I know tilting is good for your attitude and I also know for a fact that it helps with kidney function by helping you control the levels of renin and activating anti-diuretic hormones. I know one thing for sure: it does not hurt my bones and I believe it does help them when combined with careful doses of calcium magnesium and boron along with very careful levels of vitamin D3.

    Okay so there you have it. Obviously I did run on for a tiny bit but if I helped one quad of void the hell I went through from bad advice and bad care, it is worth every word I wrote.

    I believe I've outlined a successful campaign to achieve your result. Think of it as a war: you must have a strategy and you must execute your strategy to overcome the strategy of the insurance company.

    By the way, "too expensive" as a reason to deny coverage is ripe for appeal. It is a ridiculous reason, has no merit medically and offer it up as a first defense to eliminate the less intelligent of the covered population. Blow right through it with your appeal asking for a medical reason for denial. If they outsource their medical evaluations to a different firm (often a subdivision of the very same insurance company) get the name of the firm and specifically the name of the doctor. Check out that Dr. for education, training, experience with your level of injury specifically. You get the idea, attack them and re-attack them. If they have something you need and you need to pry it from their greedy hands.

    Good luck.

    Futurewalker
    Futurewalker

  8. #8
    Futurewalker,
    Thank you. I will keep fighting for as long as it takes.

  9. #9
    Senior Member
    Join Date
    Sep 2008
    Location
    West Virginia
    Posts
    111
    Is there anyone else out there besides Futurewalker who has had FES Bike coverage from Medicare, private insurance or medicaid? It looks like he got to his fes bike before they knew what was hitting them.
    Last edited by Mary Jane; 05-26-2010 at 04:21 PM.

  10. #10
    Reviving this thread. Does anyone have any success stories (and strategies) to share?

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