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Thread: Suggestions for appealing suspension boot denial

  1. #11
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    I found this on eBay . . . http://www.ebay.com/itm/Ankle-Foot-B.../291353150484? but I cannot tell if it is metal or plastic frame, so I sent the seller that question. SCI-Nurse and others, what do you think of these? There are two available and it shows "make offer".

  2. #12
    This is the first product you mentioned:

    https://www.greatmedicalsupplies.com...T-PE650SKT.htm

    This is the second product you mentioned:

    http://www.amazon.com/MMAR-Medical-P.../dp/B007ECA61K

    I don't know your husband's functional level but, I agree with KLD that there are alternatives to unload a heel sore when someone is in bed. My husband is not ambulatory. We use the SAGE Prevalons.

    Here is an option your doctor can consider for re-submitting the Orthotic paperwork:

    Pressure-Relieving Ankle Foot Orthosis . . . Diagnosis: Pressure Ulcer, Heel 707.7

    The number at the end is the International Classification of Diseases ( ICD-9 ) code that will connect the diagnosis ( Pressure Ulcer, Heel ) to the DME being ordered ( the PRAFO's ) for purposes of insurance reimbursement.

    This is a full list of ICD-9 codes for pressure ulcers: http://www.cms.gov/medicare-coverage...RangeEnd=707.9

    Ask your doctor if 707.7 or one of the others would work.

    Wishing you well.
    Last edited by 2drwhofans; 01-25-2015 at 10:40 PM.

  3. #13
    Something else to consider is that, this early in the plan year, the $340 something for both pressure relief AFO's is going to get eaten up by your co-pay and deductible-unless you've already met them.

    If you can afford it, and if his skin health is at risk, you may be able to get the devices your doctor ordered faster by paying out of pocket to the DME supplier.
    Last edited by 2drwhofans; 01-25-2015 at 10:46 PM.

  4. #14
    They would work. I wore something similar the last time i was in rehab
    T6 Incomplete due to a Spinal cord infarction July 2009

  5. #15
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    Thanks 2drwhofans! That is exactly the help I was hoping for! I will compose a letter with that information and provide the chart of other codes also. Yes, he would have the deductible on his primary, but I'm hoping that my *new* insurance (that would be his secondary) would pick that up, since there is no deductible on that. As far as the Sage Prevalons, we considered them previously, but his legs are so very heavy we surmised that they would be crushed much like the HeelLift ones are flattening with use. I will report back once we have an outcome. In the meantime we are pursuing the ones I saw on eBay as well. All the best - and thanks again!

  6. #16
    Senior Member
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    Pennsylvania
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    Thank you lynnifer - we DID get two GREAT boots from eBay - for $55 plus $10 shipping for BOTH! YAY! I think these are the same Prafo boots that are $120+ through DME companies and they seem to be i perfect condition. What is the "kick-stand" for? We had these on the other boots also and never knew what they were for. Also, as a side note, the insurance company IS approving the boots that were prescribed in the first place! We are not sure if it was the appeal we wrote (thanks for your help with that!) or the fact that they put it through MY insurance, which is Danny's secondary. Life is good.

  7. #17
    The "kick stand" (lateral rotation preventer) is to prevent the feet and legs from rolling outwards (or inwards depending on how you set them up) when laying on your back. The weight of these boots tends to pull the legs out this way, which can cause both a lateral rotation hip contracture, and pressure on the malleolus (ankle bones).

    I am not a fan of hard boots like these as I have seen people create skin problems when spasms cause the boots to hit the opposite leg.

    (KLD)

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