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Thread: Standing frame refused by insurance company

  1. #1

    Standing frame refused by insurance company

    Hi,

    I have a couple of question you guys may have experience with and I appreciate all the help in advance.

    I was recently refused a standing frame from blue cross . They told me there's no documented evident that a standing frame will help me. Any of you guys have experience with that?

    Emmanuel

  2. #2
    Did you get a letter of medical justification from your provider? While there is no documented evidence that passive standing will help with osteoporosis, there is good evidence for its use to prevent contractures, reduce spasticity (thereby reducing your need for spasticity meds) and improved bowel transit time. You can appeal the decision, and request that your appeal be reviewed by a physiatrist, who is much more likely to know about these benefits (you have the right to request that the appeal review be done by a specific type of specialist, not just a clerk, nurse, or generalist physician).

    (KLD)

  3. #3
    under UHC it is accepted.

    They have a new policy as 12/2015.

    I will find and send to you.

    Quote Originally Posted by emanshiu View Post
    Hi,

    I have a couple of question you guys may have experience with and I appreciate all the help in advance.

    I was recently refused a standing frame from blue cross . They told me there's no documented evident that a standing frame will help me. Any of you guys have experience with that?

    Emmanuel

  4. #4
    Quote Originally Posted by SCI-Nurse View Post
    Did you get a letter of medical justification from your provider? While there is no documented evidence that passive standing will help with osteoporosis, there is good evidence for its use to prevent contractures, reduce spasticity (thereby reducing your need for spasticity meds) and improved bowel transit time. You can appeal the decision, and request that your appeal be reviewed by a physiatrist, who is much more likely to know about these benefits (you have the right to request that the appeal review be done by a specific type of specialist, not just a clerk, nurse, or generalist physician).

    (KLD)
    Here's what the doctor wrote and also what the insurance wrote to me.Please let me know your thoughts
    Attached Images Attached Images   

  5. #5
    That is not much of a LMN -- very vague, no citations, multiple misspellings. If necessary, draft an enhanced one yourself citing available literature and have your MD sign. EasyStand may have some examples, but don't copy. KLD said it all as far as the appeal process.

    The RESNA position paper is obviously an important citation.
    Last edited by renard; 04-13-2017 at 05:34 PM.

  6. #6
    Senior Member
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    I submitted two LMNs and 9 (yes, NINE) peer-reviewed papers on why dynamic standing frames (EasyStand Glider) help with blah blah blah and my insurance denied it and denied the appeal stating BOTH TIMES that "there is no evidence that static standing frames prevent bone density loss."

    i.e. they focused on only one benefit and ignored the fact that it was not a static standing frame.

    Private for-profit insurance has no incentive to help chronically injured people. We're just loss centers. Their best case scenario is we die.
    T3-T7 complete since Sept 2015

  7. #7
    Here are some policy statements:
    https://www.unicare.com/medicalpolic...pw_b099008.htm (See Other Conditions, especially paragraph two in that section).
    https://med.noridianmedicare.com/web...ncovered-items

    Medicare (Nordian - 2nd policy statement) seems not to cover standing frames either. It may be an uphill battle.

    Anyone here had a standing frame paid for by Medicare or private insurance?

  8. #8
    Senior Member GJ2's Avatar
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    I found this after reading this post. attached is a .pdf from united health care .. very interesting as I have them for my medicare ...
    Attached Images Attached Images

  9. #9
    I think part of the problem is the piss-poor justification letter you got from your physician. Look at the attachment above. Their letter needs to address in detail and with great specificity each of the required criteria listed, individualized for you.

    (KLD)

  10. #10
    Senior Member
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    Quote Originally Posted by GJ2 View Post
    I found this after reading this post. attached is a .pdf from united health care .. very interesting as I have them for my medicare ...

    me to but i bought a standing frame in 2003

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