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Thread: Standing frame refused by insurance company

  1. #11
    Back in the day, probably 1985, my private insurance through the company for which I worked, covered my standing frame...but hey! that was back when dinosaurs roamed the earth. Today...anybody's guess.

  2. #12
    Senior Member Andy's Avatar
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    Quote Originally Posted by gjnl View Post
    Anyone here had a standing frame paid for by Medicare or private insurance?
    Yep, BCBS IL. BUT, and a big BUT...apparently they screwed up some sort of preapproval process with a DME vendor, which they tried to weasel out of. One inbound to me phone call they actually got rather aggressive trying to get me to accept non-payment. I told them it was approved per their process or some such thing (this was over 10 years ago, memory sucks) and ended that call. A week or two later the DME said my account was mysteriously paid by BCBS with no itemized description what the payment was specifically for. It was quite the battle, both by me and the DME that I was working with in concert on this issue. But it did get paid. Thinking back I'm wondering if the heartburn was worth the $$$, but I guess it was after all.

  3. #13
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    We had to appeal this 3 times with BSof CA. They finally paid for it. An attorney friend of mine ( she worked for Kaiser a few years ago) said that most insurance companies don't expect the people to appeal so they always deny a claim initially. We appeal everything and usually win in the end.

  4. #14
    I think the justification letter is garbage, but to be honest, the data does suggest that a standing frame is of no medical benefit, so the insurance company might refuse no matter what.

  5. #15
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    It all comes down to how well the letter of medical necessity is written. When I was considered for a spinal cord stimulator, the insurance company initially turned down the request. The pain interventionalist rewrote the letter of justification and the same request was approved.

    Similarly, my physiatrist recommended that I get a standing frame. When I went for an evaluation by a PT, she determined that I would benefit from it. However, since I couldn't pump myself up ( I have a progressive neuromuscular disease) she suggested I get a standing wheelchair. It took the coordinated effort of a RESNA PT, my PT, the physiatrist, the DME, and Permobil, but they apparently crafted a good letter of medical necessity. I was approved for a Permobil F5VS on the first try.

    Thus, I think that it comes down to the effort put in to the letter.

    I would suggest you try again.

    The best of luck.

  6. #16
    BCBS-IA approved one for me in 2014, but it was all handled by my psysiatrist and therapists while I was still in rehab, so I have no idea how they did it. It can be done, though. I know they had to argue for the various pieces of equipment they lined up for me, and for some reason, they had more resistance on my shower chair than on the stander.

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