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Thread: lots of DME questions

  1. #1

    lots of DME questions

    I'm new at all this stuff, and my son's rehab facility isn't helping at all. Sigh.

    I'm wondering are there certain items that are generally covered by insurance companies? (We have a really good United Healthcare policy.) For example, are shower chairs/commodes covered? If not, does Medicaid cover them?

    As far as DME, do we need a prescription for every little thing? Like even chux? (And, does Medicaid cover that?)

    Do other people have trouble getting their doctors/PT's etc. to write rx's for items? Ours aren't doing anything for us - only the hospital bed and wheelchair....oh, and the slide board (which isn't covered by our insurance...maybe Medicaid on that too???).

    I'm really wondering what items I need for my son, who is coming home tomorrow. (They just told us yesterday.) Surely he could use more than just the bed and wheelchair?!?

    What is the best kind of mattress (he's a C5/C6 inc)? They are saying just a bubble overlay is fine. I thought low air loss mattresses were best?

    And what about the IPD things....those cuffs that go around his legs and inflate. Wouldn't that be useful? But they won't write an rx for that either. Sigh.

    Finally, if anyone knows any good DME's in SW Ohio...or any helpful advice whatsoever....I'd really appreciate it.

    Thanks so much!

  2. #2
    get ahold of your insurance company with a major claim like that you should have a special claims person attached to the case. we had the same problem when dalton got hurt, once we got assigned to someone from blue cross we finally started to get some answers as to what was and was not covered. the health care providers have no clue what if anything is covered by your insurance it all depends on the plan you have. call them and ask for someone to be assigned to the case I hope this helps because I know the frustration that you are going through. good luck

  3. #3
    We've been trying to get a case manager with the insurance...to no avail so far. We'll keep trying though. Thanks!

  4. #4
    We had a case manager from BCBS call us when my husband was first in the hospital after his accident. She actually was a lot of help after some of the horror stories I'd heard about them.
    When we left Craig Hospital everything had been ordered and shipped to our home. We were so lucky to have a good family service worker to help through the maze.
    I wish I had some suggestions and am really frustrated for you.
    Hopefully some of the good people here will.

  5. #5
    Make sure you have a competent lawyer who is knowledgable in insurance claims. It makes a Big difference for getting needed items and nec. equipment. Insurance, Fed and private are known for denying a claim before accepting it.

    Is he coming home from rehab. or is he in between hosp. and going to a rehab? If he's under 21, Shriners helps out a lot.

  6. #6
    I have United Health Care as well. When I was injured they assigned a case manager to me and 2 years later she is still helping. Insurance is a pain, but the case manager was a big help. For me shower chair, chucks, and etc.. were not covered, but Cathators, Tilte ZRA, standing frame, were covered. Sometimes you will have to call them a couple of times, but again they are pretty good. But ever policy is different.

  7. #7
    Senior Member jschism's Avatar
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    Quote Originally Posted by Patrick Madsen View Post
    If he's under 21, Shriners helps out a lot.
    the childrens hospital over there(cincinatti) has spent a lot of money upgrading the services for SCI, they even have a lokomat. they have seen some patients that have been thru motion based therapy and have caught on to the good it has proven to be.
    Last edited by jschism; 09-15-2010 at 11:39 PM. Reason: clarification

  8. #8
    We had United Healthcare when my husband became paralyzed. Don's doc at the rehab wrote prescriptions for supplies, the insurance paid for disposal diapers, chux, wheelchair. We paid for slide board and caths. The DME told us our rehab shower chair would be covered by insurance, but insurance balked, but the DME had delivered it to us already, and I think he absorbed the cost himself. Apparently they will pay for a bedside commode though. They also initially refused the entrance lift we needed to get Don in our house. I wrote a letter, appealing, saying I had no other way to get him home, and they agreed to fund that also. I tried the a local league of human dignities to help fund modifications to the home, but they based our application on the previous years income, and said we made too much money (of course, Don wasn't able to resume his mechanics job after being paralyzed), but they told us to try back the next year. I was angry, so grabbed a hammer and removed interior doors and trim, built a threshold ramp myself, and we got him home. I don't have experience with Medicaid, but I think you have to be in a certain income bracket (or if your son is old enough, he would have to be in a certain income bracket) to qualify for assistance. Do you have an Assistive Technology in your state? They have equipment to loan, rent, and sometimes free. They will also help you with some home modifications and will help your son to continue education or help with vocational rehabilitation/jobs and possible transporation. Last, I don't think the inflatable compression boots are covered by anyone. Hope this helps, and happy day, your son is coming home! Things will get better.

  9. #9
    Welcome dsmartin...yes! he's coming home! Sadly not to put a damper on that...what I have found to be the truth for me, as a mom who cares for her adult son...get strong! stay strong and don't let anyone get in your way...go to the top... as far as your sons needs and care are concerned...

    Don't settle for for an air overlay...as a c5, he does need an air loss mattress...right off the top they will say "not covered" he needs a pressure sore before it would be considered...reply that when they have to spend lots of $$$$$$ and hospital care, perhaps they will reconsider..sadly, we have had to fight for everything and after a while you just want to give up say #$^&*^*&^ (fuck it)...we ended up buying the showerchair actually found one here on cc...the exercise equipment and an extra back up chair because when the chair breaks, it has taken MONTHS to get repaired...they don't care if your son has to stay in bed until it's fixed...sorry this sorta got in "rant" mode...which brings me to the private caregiver forum...not to keep others out...sort of a safe place we have...my son lurks mostly on the forums and I would hate for him to read crap that I might have written in frustration and anger...

    I have learned sooo much from these forums, keep coming back! and know the natural knowing you have in your heart and as a MOM will guide you...hang on, you are in for the ride of your life...Just know and believe it DOES get better, just wish I could tell ya when...read back posts and you will learn all about SCI...and the wonderful people who share their triumps and pain...hugs, judy

  10. #10
    Thank you all for taking the time to respond. I really appreciate the input! I'm sorry it has taken me so long to reply. Things are so hectic here now that our son is home. Only an hour after bringing him home we realized there was a problem... I suspected a UTI and sparing you the details they should've known it too. I wasn't at the rehab hospital the day before he was discharged (I was trying to get things ready at home) but had I been I would've noticed there was trouble when I cathed him. Not to mention they discharged our son knowing something was up because his BP was high.

    Any rate we called his doc who told us to get out son to the nearest ER and get him treated and that would resolve the BP issue. That was a real trip since we don't even have a handicap equipped van yet. Who would have time to look for a van??

    Sorry to digress, we are trying to get the things we need for our son, but it has not been easy... I suspect it will always be this way. We've been trying to get in touch with our insurance company for 9 weeks now.. all to no avail. I am filing a complaint against them Monday with the state insurance board. I hope that helps get the ball rolling and someone will at least talk to us.

    Thanks again for all your help! You guys are all so nice!

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