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Thread: Letter of Justification for Private Insurance to Cover Attendant Care

  1. #1

    Letter of Justification for Private Insurance to Cover Attendant Care

    I am a C5 quad and had Medicaid for 10+ years to pay for attendant care. Once I was working and lost my eligibility for Medicaid, I paid out of pocket for my mother to help with attendant care in the morning and at night. I recently moved out and got married, and am trying to get my insurance provider to cover about 8 to 10 hours of attendant care per week (for showering and bowel program). My insurance says that attendant care is not covered, but I can write a letter to my state's Bureau of Human Resources (I work at a university and am on the state employee health plan) to try to get it covered. Has anybody gone through a similar process? If so, do you have a letter or resources that I can use to convince the state that attendant care is a medical necessity for me that should be covered?

    Thank you for any help or guidance you can offer!

  2. #2
    Good luck. It is unlikely that this would be covered, as such care is not considered skilled nursing care, nor is such care considered to result in an improvement in your condition, but instead is considered "maintenance" care. Outside of worker's comp or some VA programs, I know of few funding sources that cover attendant care like this.

    (KLD)

  3. #3
    Senior Member Vintage's Avatar
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    Cjo, I'm going through something similar. I'll give you what I "think I know", but you'll have to verify it with someone else. Medicaide plays its cards close to its chest. It's crucial that your doctor documents that you need a nurse. I don't know the frequency. Daily? Weekly? Monthly? And what for? With the 'need' for a nurse established, THEN you are in line for an aide. No need for a nurse = no aide either.
    Female, T9 incomplete

  4. #4
    Sorry no advice about the funding for attendant care, but I wanted to point out that when I worked, the Federal Tax Return had something like 'work related disability expenses'. If you could check out a tax manual, maybe google this, you may find this is still in effect. It allows a disabled person to place a number of expenses in that category and NOT under "Medical Expenses" - which only allows a small percentage as deductible. As I recall such expenses were listed under "Miscellaneous" on the Return form, near the bottom of the deductions page.
    The 'Work Related' category allows a full deduction of items.
    I would list a percentage of van modifications there (hefty expenses), and once when purchasing a new van I did the math to figure out how much the van cost vs. a standard automobile, then deducted a percentage of the van cost as used for work days. I would certainly think that your attendant costs on work days would go there,
    again, taking a percentage of the total costs.
    Thus, if you are ever audited, this detailed breakdown would protect you.
    Hope this helps a bit.

  5. #5
    All I can do is offer my best wishes and hope that it works out for you. I do not think it is likely that you are going to get insurance to cover it, but in this case I really do hope that I am wrong

  6. #6

    Employer may be self funded

    Quote Originally Posted by joeycares View Post
    All I can do is offer my best wishes and hope that it works out for you. I do not think it is likely that you are going to get insurance to cover it, but in this case I really do hope that I am wrong
    Sounds as if your employer may self fund their insurance. I don't know that for sure. It is just a guess.

    if that is the case then you would need to appeal to whomever is in charge at your employer. Typically the director of HR or something along those lines.

    Usually when an employer self funds they still contract with an insurance company to manage the process but ultimately it is the call of the employer what they will and will not pay for.

    So your advantage may be that in appealing to your employer they do not stick to the policies of the insurance company.

    Perhaps you can appeal to someone's kind heart and get them to approve this for you.

    My guess would be that you get denied, however, since your employer is a public institution and not a for profit-based company maybe you have a shot.

    it is certainly worth a try.

    Again, I could be totally wrong about your employer self-funded.

    Hopefully this is helpful to you.

  7. #7
    Senior Member Vintage's Avatar
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    I'm just stating the obvious, but it's a real shame that when you started working, that caused you to loose your Medicaid...and you aide.
    Female, T9 incomplete

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