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Thread: denied

  1. #1

    denied

    Ok, I was denied for a wheelchair claim I subbmitted, today... My insurance company told me I can file appeal.... Do anyone know how I should go about filing appeal? Some samples or something?

    I would like to hear about someone who have been there, done that..

    I start school in aug, I doubt if my appeal is granted ( which will take a few weeks for a decesion ) and the time it take to receive, school will have started..

    Peace

  2. #2
    mad....

    you currently have NO chair you can use now, at least while your claim/appeal is decided ? Is your current chair in disrepair?

    typically, insurance likes to see if chair that is currently in use can be repaired. If not, or the cost does not warrant repair over just getting a new chair, then new chair may be provided (also depending on time since last chair was approved). But in filing an appeal (im not sure what insurance you have) generally, you can re submit a letter of need, which further explains your NEED for a new chair, Identify all things relevant to how a new chair will help improve mobility/function in your every day activituies. also, include your goals for school and how a new chair will contribute to your gaining better access to your classes and getting around campus, thus help toward your goal- as a student and long-term career and self sufficiency, etc) Make sure your doctor and physical therapist, if necessary, identifies additional medical need if they can, which can help to justify your claim as medical necessity. if you have no functioning chair now, include how Not having a chair has limited your abilty to function as well as you could and how it may have increased your dependence on others, which would then result in increased need for a personal care attendant (which then would increase cost to provide that service, which may be a more costly tradeoff for your insurance in the long term, if they are paying for it)

    hope this gives you some ideas. if i think of anything else, ill post. good luck!.

  3. #3
    Mad...I forget to mention, that there is an "appeal process" that should be outlined where they told you you could appeal. Follow that process. sometimes (depending on your insurance) there may be several steps, including submitting another claim or reqesting a hearing , etc. thing is, be PERSISTENT. Insurance is about containg cost, NOT about providing you the care you need necessarily.

    Hey.. I just remembered also, you are going to school. if your insurance denied you and there is little chance after the appeal that you will be approved, try the Office of Rehab Services- Vocational services to get a chair. You can use your goals for school and future employment etc, to help justify need for new chair. They may want you to go through all other avenues, like your insurance first, then as final option, they will consider paying for the chair.

    I may be repating what you already know..but just be Persistent and get on their ass!

  4. #4
    Member beelady's Avatar
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    Mad,
    I just mailed an appeal off to my insurance company. They dont want to pay for 3 separate "facility" charges when my son was at TIRR. The charges were an evaluation, a group therapy session, and a reentry dinner so needless to say, I am appealing. Talk to your case manager at your insurance company. She should direct you. I wrote a letter stating why I thought it should get paid and then had Jesse's PT send me a letter so I could mail that along also. Good luck

  5. #5
    Chick

    The chair im in now is totally messed up, from armrests,footrests,backrest upholstery, etc etc...

    It's causing skin problems around my ribs. Like you said I need to be persistent.. I will be moving in mid-august, so I doubt if my chair will be appealed by then. I will have to figure something out..

    Also the voc rehab services told me they will only pay for school,equip,etc, until I have 12 credit semester hours..

    Im getting the quickie ti,so I can get my chair in and out my car. The folding one I got is a pain it's like 50parts to it..

    Do you hav any samples?

    BeeLady,
    What kind of letter the pt write?

  6. #6
    Mad....come in the chatroom....

    Miss Mary

  7. #7
    Member beelady's Avatar
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    Mad,

    She wrote what each disputed session was all about, why it was an important part of Jesses therapy and stressed that each was indeed part of the rehabilitation process. If you could get your doctor to say you needed the lightweight ti chair vs. the heavier one, it might be somewhere to turn for you. Did your insurance company already pay for one for you??? I remember Jess's OT saying that companies dont like to pay for the ti since they are so expensive compared to the heavier ones, but Jess got one since he is a quad and needed a light one to load and unload. How about u?

  8. #8
    Senior Member ~Patrick~'s Avatar
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    Mad- Get whoever wrote the script for the chair to outline why you need it. Make sure they stress prescription changes from your original chair.


  9. #9
    Senior Member
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    Originally posted by MAD-PRODUCER:

    Ok, I was denied for a wheelchair claim I subbmitted, today... My insurance company told me I can file appeal.... Do anyone know how I should go about filing appeal? Some samples or something?

    I would like to hear about someone who have been there, done that..

    --------
    MP,
    It usually just takes a letter, nothing formal but you should probably call the claims office or whatever they tell you in the letter of Denial. You need a Doc. to use the magic words which are usually something like "medical necessity" in his letter or prescription or both. Keep after them by phone, mail and dont let time go by. Tell them the old one is causing skin problems. They have Doctors reviewing all claims. Keep copies of all correspondence. Good luck WR

    I start school in aug, I doubt if my appeal is granted ( which will take a few weeks for a decesion ) and the time it take to receive, school will have started..

    Peace

  10. #10
    Originally posted by beelady:

    Did your insurance company already pay for one for you??? I remember Jess's OT saying that companies dont like to pay for the ti since they are so expensive compared to the heavier ones, but Jess got one since he is a quad and needed a light one to load and unload. How about u?
    Are you asking did my insurance pay fo a Ti? If so, No they haven't payed for a Ti.. This will be my first Ti.......

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