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Thread: Need cases where Medicare paid for standing frame

  1. #11
    DaleB, Thanks for your encouraging post.

    My denial is based on the Medicare "rules that state a combination sit-to-stand system (Code E0637) is a noncovered item." They are not disputing that it's medically necessary.

    The EasyStand.com case happened when the new standing frame HCPCS codes were introduced in 2004, so it could have been coded E0637 or E1399 according to Nancy. Here's a link to that case:
    http://www.easystand.com/standing-ro...m?genericID=25

    With enough precedent gathered together, there's the possibility of changing Medicare law, so I definitely think this is worth fighting for.

    In the meantime, I'm imagining laundry hanging from my EasyStand when my ancient dryer gives out - thanks for the tip!:-)

  2. #12
    Senior Member DaleB's Avatar
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    I'll see what I can find on those codes.

    Lobbying recently changed the catheter rules, so change is possible!

    Kudos to you for being pro-active!



    Quote Originally Posted by beatscookin View Post
    DaleB, Thanks for your encouraging post.

    My denial is based on the Medicare "rules that state a combination sit-to-stand system (Code E0637) is a noncovered item." They are not disputing that it's medically necessary.

    The EasyStand.com case happened when the new standing frame HCPCS codes were introduced in 2004, so it could have been coded E0637 or E1399 according to Nancy. Here's a link to that case:
    http://www.easystand.com/standing-ro...m?genericID=25

    With enough precedent gathered together, there's the possibility of changing Medicare law, so I definitely think this is worth fighting for.

    In the meantime, I'm imagining laundry hanging from my EasyStand when my ancient dryer gives out - thanks for the tip!:-)
    __________________

    He who hears not me but the Logos will say: All is one.

  3. #13
    We don't need to walk (or roll) away politely after our insurance companies, Medicare/Medicaid, VA, etc. deny our durable medical equipment or medical treatment.

    I have gotten a lot of tactical information on how to battle the insurance industrial complex from Laurie Todd's book "Fight Your Health Insurer and Win." If interested, look her up on YouTube or go to her web site.
    http://www.theinsurancewarrior.com
    (disclaimer: I have no monetary interest or affiliation with her)

    So for me, spending months or even years going through the appeals process is definitely worth it. I have nothing to lose and who knows, I may end up with money in my pocket, not to mention the possibility of getting the rules changed.

    Thanks again, DaleB for your positive words!:-)

  4. #14
    many of us have fought these battles. i was on the news over it (not medicare, but my work provided insurance). don't try to change medicare, but fight them, esp. on local tv news. they love these stories. the media is your best ally as you're only talking to ppl w/no power at medicare or private ins. they're told to deny. good luck.

  5. #15
    Thanks Cass for your advice. I like the part about local TV coverage. I'll have to do some thinking about that. Did you win your work insurance case?

  6. #16
    Quote Originally Posted by beatscookin View Post
    Thanks Cass for your advice. I like the part about local TV coverage. I'll have to do some thinking about that. Did you win your work insurance case?
    yes. all it took was being on the media. most cities have a troubleshooter reporter. fastest way i ever got anything resolved. months of appeals were getting me nowhere, including work health ins. saying things in writing that i was asking for items for "social convenience."

  7. #17
    Quote Originally Posted by cass View Post
    yes. all it took was being on the media. most cities have a troubleshooter reporter. fastest way i ever got anything resolved. months of appeals were getting me nowhere, including work health ins. saying things in writing that i was asking for items for "social convenience."
    That's great to hear you won your case. Sounds like you're a fighter, like me. I find it so ridiculous when insurance companies call something a "convenience" instead of medically necessary.

  8. #18

    Nancy Perlich currently collecting data

    I have great news! Nancy Perlich, funding specialist for EasyStand, has agreed to be the gathering point for info from folks who've fought & won a standing frame denial from Medicare.

    Anyone can send as little or as much info as they like to her and she will be able to redact all sensitive info for privacy. Her contact info:

    Nancy Perlich COTA, ATP
    Altimate Medical, Inc.
    P 877.844.1172
    F 952.937.0821
    www.easystand.com
    nancy@easystand.com

    I've had many encouraging correspondences with her and she really is dedicated to getting this equipment funded for people. Nice lady.

  9. #19

    Medicare advantage plan pays for my stander!

    I just won my appeal! Now my medicare advantage plan has to reimburse me for my EasyStand. Yay!

    Things really came together after Nancy Perlich from EasyStand hooked me up with an attorney from Disability Rights Texas (and I don't even live in Texas!). He spent a lot of time with me and turned out to be a really great guy who is passionate about getting laws changed. He knew exactly how to present my case to the ALJ judge. And this was all at NO COST to me! Disability Rights is a pretty cool organization. I had previously contacted the one in my state regarding this case but they said they couldn't help me. I had no idea that I could go to one in another state. This just proves that we should never give up!

    I hope this will inspire everyone to keep appealing and challenging insurance/Medicare/Medicaid, because there is hope. And thanks to all of you who contacted me privately to help out. This really is an amazing online community!

  10. #20

    Thumbs up el guapo

    It is a royal pain in the Glutimus Maximus but worth the battle

    They are el guapo cheap

    For year's I've dealt with appeals / denials and hearings etc..... The main ting is to be persistent

    I still go through tons of junk for bloody lightweight rims ,,
    Just seen my Regional nurse yesterday in person she gave me heck on lousy rims . Like she is paying for them out of her pockets

    So much for my hard work and taxes etc.... I paid into the system long ago she is a goon KhhhKa Ching I just opened my register



    So in meantime I am still looking for any lightweight 24'- 25 spoked rims/ tires
    It's rough but i'll find em items ...


    Dear Politico noddle heads YaAll crack me up on these ;
    frivilous medicaid / medicare cutbacks - Assanine politicians need to spend a few weeks 24/ 7 in wheelchair maybe these jerks will get a taste of their own medicine .


    If it looks like crap and smells like crap maybe they will realize theyre full of crap

    Sooo Heres to you To all you wetback Politicians cutting back on our medical necessary items
    Do me a Favor It's not much I ask for ok ????
    I'll bend over for ya so you all can kiss my glutimus Maximus

    Bye

    Have a good day

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