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Thread: health insurance

  1. #1

    health insurance

    what health insurance doese everybody have that will pay for the purchase of the top end chairs like ti-lite iam on medicare now and my understanding they will not pay for a ti-lite

  2. #2
    medical mutual. any private ins rep
    c4/5 inc funtioning c6. 28 yrs post.
    sponsored handcycle racer

  3. #3
    thanks .. what are some names of private insurance ??

  4. #4
    also doese it need to be PPO or HMO

  5. #5
    Senior Member wheeliecoach's Avatar
    Join Date
    Dec 2005
    East Haven, CT
    United Healthcare PPO
    "Unless someone like you cares a whole awful lot nothing's going to get better. It's not." - Dr. Seuss

  6. #6
    thank you do you have a sugestion on which plan with united healthcare??

  7. #7
    Please correct me if I'm wrong, but I thought private insurance companies wouldn't reimburse for durable goods if there's a pre-existing condition?

  8. #8
    Senior Member
    Join Date
    Apr 2008
    Olympia, WA
    My company has Regence Blueshield, and they paid 80% on my Quickie Ti without much fuss. And it was definitely a pre-existing condition! I just had to get a prescription from a orthopedic doctor to convince 'em I needed the light weight model.

  9. #9
    The first issue if you have a SCI is getting insurance at all AFTER your SCI, or keeping a plan you had before (often they are cancelled by the insurer). Group plans (with an employer) are the most likely to be available, as private plans may not agree to insure you, as an individual and if they do, are often prohibitively expensive. Pre-existing condition clauses may require a wait of a year or more for coverage of that condition, or may preclude ever covering it. This is less likely with a group plan than with an individual plan.

    Most group plans will cover some DME, but it will vary widely what they do and do not cover. This is regardless of whether or not the plan is a traditional indemnity plan, a PPO or an HMO. Even within HMOs there is a difference. For example, some employer Kaiser HMO plans have no DME coverage, while others have limited coverage. It all depends on the specific plan, and every plan is different by employer, state, or even region within the state. Northern CA Kaiser is different than Southern CA, for example.

    Regardless, you have the ability to appeal the decision of any insurance company, including Medicare. Your success of course will vary with the plan, the quality of the medical justification you provide, and what it is you are trying to get.

    If you are looking for a lightweight chair, be sure that your provider (or whomever is writing the letter of justification) is citing as a reference the clinical practice guideline on upper extremity management in SCI (you can find the link to this at the top of the Care forum). There is strong justification cited in this document for getting the lightest manual chair possible with a direct connection between heavier chairs and significant risk for shoulder damage and pain. PTs or OTs who are expert in SCI often write a much better letter of medical justification than a physician does, although a physician will need to sign it.

    Last edited by SCI-Nurse; 04-24-2008 at 09:39 PM.

  10. #10
    thank you were is the link at?

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