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Thread: Appeal Letter for Titanium Upgrade - help me write one

  1. #11
    Did you contact TiLite to ask for their advice? Sometimes I find the providers often have advice for insurance claims. Alternatively, I believe that some insurance companies will automatically deny a titanium frame but they're OK with a 'titanium upgrade' to an Aero Z. Maybe as a last resort (since you'll still need to pay for some upgrades out of pocket).

  2. #12
    My understanding is that doctors write prescriptions and then therapists write the details in the letter. Better that way for you. Because the wording is very important and a good physical or occupational therapist is better at that than most doctors.

  3. #13

    Bureau of Vocational Rehabilitation (BVR)

    I injured my left shoulder last August just from painting my basement floor. I got both elbow and shoulder tendonitis at the same time from painting. My orthopedic (shoulder) doctor gave me the right act about using a light weight 'chair.

    See your orthopedic doctor and get a letter from him since you already had a shoulder injury and have one now.

    If you are employed why aren't you going through your state's vocational rehab to cover this 'chair? My state rehab purchased me a titanium TiLite 'chair and a shower 'chair. There should be no questions asked with BVR covering the cost of a titanium 'chair to keep you employed. I would also use the letter from your orthopedic doctor with BVR to support your case.

    Ti
    "We must overcome difficulties rather than being overcome by difficulties."

  4. #14
    Quote Originally Posted by Crappler View Post
    how old is your current chair?
    8 years

  5. #15
    Quote Originally Posted by titanium4motion View Post
    I injured my left shoulder last August just from painting my basement floor. I got both elbow and shoulder tendonitis at the same time from painting. My orthopedic (shoulder) doctor gave me the right act about using a light weight 'chair.

    See your orthopedic doctor and get a letter from him since you already had a shoulder injury and have one now.

    If you are employed why aren't you going through your state's vocational rehab to cover this 'chair? My state rehab purchased me a titanium TiLite 'chair and a shower 'chair. There should be no questions asked with BVR covering the cost of a titanium 'chair to keep you employed. I would also use the letter from your orthopedic doctor with BVR to support your case.

    Ti
    I got nothing but great things to say about North Carolina voc rehab. They bought me a standing chair and put almost $100,000 towards my education in total. But I don't think I'm qualified any more (hell maybe I'm wrong, that would be awesome).

    A summary of my interaction with voc rehab:
    I was finishing undergrad and looking at going to professional school afterwards. Lucky for me I didn't know voc rehab was a thing during my post injury undergrad years. I was trying to figure out how I could afford a standing chair because I thought (incorrectly it turns out, but there was no way to know that in advance) that a standing chair would be a necessity for my continuing education.

    Someone told me about voc rehab, I tracked them down and found my local office after a missed visit or two I got a meeting with a (counselor? is that what they're called?) and told them I was hoping to get a standing chair to help me continue my education. They got a little information from me and about thirty minutes later they asked me how would I like for them to pay the entire four years of tuition I was looking at... pretty sure I gave them a blank stare, because I knew damn well that was on the North side of $80,000. I said "yes, please, thank you, you guys are awesome" and they replied "oh and of course if you need books or any other supplies, please let me know, we will cover that too". Believe you me, I had lots of books and a fair few thousand dollars in other supplies that they happily paid for three years, then the counselor changed the fourth year and they got really picky about whether or not they would actually pay for books, but who am I to argue, they paid out almost $100,000 in total. Then I fucked up like the fuck up I am and had to stay for an extra semester which they wouldn't cover, but I don't blame them at all for that, I'm just glad to not be stacking up $7,000 a year in student loan interest payments as I complete my education.

    Anyways, after all was said and done with school I got a job (two years ago) and moved to a different state. Got employer provided insurance, became ineligible for medicaid after a couple months (not that it mattered, I was out of state anyway). This triggered NC voc rehab to give me a call. They were like "you good? can we close your case?" and I said "thank you so much, you guys are awesome, if you need any favors (even sexual ones), just let me know, I owe you guys so much!!!" and that was that.

    So in the current state I'm in (geographically, not emotionally) I've only ever been employed and making a decent income (a quick google search tells me that my single ass is making about $10,000 more than the median household income round these parts) so I just assume I'm not going to qualify for voc rehab.

    But maybe I'm way off. Like I said I didn't even know that vocational rehabilitation was a thing while I put myself through 3 years of undergrad post injury (and thank Jah that I didn't because I would have blown my four years of vocational rehab sponsored tuition and books on a cheap sub-par state school rather than on much more expensive professional school).

    Any kinda doubt I would qualify, googling my local voc rehab, their website says "Follow-up, post-employment and job retention services[COLOR=rgba(26, 26, 26, 0.7)] help if your job is jeopardized because of disability-related factors."
    [/COLOR]This definitely isn't the case, my job isn't threatened any way I look at it. I could easily do my job from an aluminum chair it would just put more wear and tear on my shoulders, and I can afford to pay for the $1500 for an upgrade, it will just mean a little less money for beer and 9mm ammo on the weekends (obviously those are two separate hobbies which are never performed in tandem) and continued deferral of my (laughably small considering the years of school I've done) student loan debt. [COLOR=rgba(26, 26, 26, 0.7)]

    [/COLOR]

  6. #16
    Quote Originally Posted by gjnl View Post
    Found on Page 3:
    Wheelchairs and coverage criteria
    Ultralight Weight Wheelchairs - Manual
    2. Titanium frame has marginal weight advantage over aluminum frame; considered not medically necessary.

    So then I'm wondering if citation of not only a weight savings but also a durability difference would make an impact. Also, Aluminum is less flexible than Titanium and doesn't absorb impacts as well. Thus, a Ti frame for someone who has pain and joint issues can make a big difference over the course of an active day. If this is presented properly, I wonder if it would be considered enough justification.

  7. #17
    Senior Member Oddity's Avatar
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    Quote Originally Posted by cutterjohn View Post
    So then I'm wondering if citation of not only a weight savings but also a durability difference would make an impact. Also, Aluminum is less flexible than Titanium and doesn't absorb impacts as well. Thus, a Ti frame for someone who has pain and joint issues can make a big difference over the course of an active day. If this is presented properly, I wonder if it would be considered enough justification.
    Couple issues here, IMO. TiLite doesn't publish "expected frame life" as being any longer for their Ti frames than, say, Quickie (and everyone else really) does for their Al alloy frames. They have to make the Ti tube walls so thin for it to actually be lighter they don't really last any longer, nor are they apparently warrantied for longer. Titanium chairs being more durable is not a published fact. They crack often, in reality. Plenty of examples of that here. Now, if TiLite would engineer their tube and chairs to take advantage of Ti strength (instead of focusing on shaving a pound or two), and published a 10 year frame life instead of the industry standard of 5, you might be on to something.

    Flex (and vibration damping) is based on frame and tube design, not material. A box frame TR doesn't flex. A 1.25" tube ZR frame doesn't flex. At least not enough to be considered therapeutic damping, e.g. Froglegs or a real suspension (Icon). Caster material and tire pressure are the big contributors to damping on any wheelchair.

    While you're right, based on the "on paper" material properties of Ti vs Al, how these chairs and tubes are designed doesn't really allow those properties to much matter, and the payer industry has largely figured that out.

    This is all my opinion, however informed that may or may not be. I don't and won't discourage anyone from trying to appeal for what they want. I do encourage folks to read THEIR specific company's DME and wheelchair policies and craft a counter-argument addressing the specifics of said policy.
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  8. #18
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    Don't rule out Voc Rehab. After I was injured PA Voc Rehab sent out a counselor who deemed me too disabled to rehabilitate. Not happy with that conclusion, the second counselor they sent out got me into the program. Paid for my van adaptions, college and books. 25 years later I'm living in Florida making a pretty decent salary with a Govt job. My Dodge Truck starts having problems and then the Braun adaptions start having problems. I set up an appointment with Voc Rehab and go through the paper work. The salary results in a denial of services. I tell the counselor no problem, I understand. I'm getting into my truck and she comes out to tell me they will file for an exemption and see what happens. The program is in place to help people succeed. Two weeks later they tell me the will pay for the vehicle adaptions if I buy the vehicle. A lot depends on which counselor you get.
    "Never argue with an idiot; they'll drag you down to their level and other people may not be able to tell the difference."

  9. #19
    Quote Originally Posted by 24/7 Quad View Post
    Don't rule out Voc Rehab. After I was injured PA Voc Rehab sent out a counselor who deemed me too disabled to rehabilitate. Not happy with that conclusion, the second counselor they sent out got me into the program. Paid for my van adaptions, college and books. 25 years later I'm living in Florida making a pretty decent salary with a Govt job. My Dodge Truck starts having problems and then the Braun adaptions start having problems. I set up an appointment with Voc Rehab and go through the paper work. The salary results in a denial of services. I tell the counselor no problem, I understand. I'm getting into my truck and she comes out to tell me they will file for an exemption and see what happens. The program is in place to help people succeed. Two weeks later they tell me the will pay for the vehicle adaptions if I buy the vehicle. A lot depends on which counselor you get.
    It feels a little icky asking for them to pay when i can easily afford it. It’s like a month and a half’s rent.

    the insurance company on the other hand, this is why me and my employer give them thousands of dollars a year.

  10. #20
    Quote Originally Posted by Oddity View Post
    Couple issues here, IMO...
    What I'd like to see is a definitive study of weight, durability, and shock absorbance for equivalent frames in Ti or Al. Then, we would have either a resource for saying Ti doesn't really have an advantage and people like me could stop worrying about how to get it covered, or it does have an advantage and people like me would have hard evidence to back up our insurance claims.

    In my previous life, I was a serious bicycler. Though I never had the $$ to get a titanium frame, it was widely understood that Ti frames were more forgiving and springier than Al frames. This is in spite of the fact that most of the cushioning comes from tire type and pressure, saddle type, and frame geometry (e.g: fork rake). Even with all these variables, Ti made a huge difference in how the bike punished you over a long ride. Metallurgically, it was also understood that Ti doesn't fatigue over time like Al does, and so lasts longer. What I don't know is how much of that is at play in a wheelchair frame, given the points you make about tube thickness, etc. That's why, again, I'd like to see a serious study. A statement like "A 1.25" tube ZR frame doesn't flex" is fine to make, but it would be better to have something to reference with it.

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