Turned down for FES

laura26 · 12-02-2003, 11:55 AM

Well...my insurance company, BC-BS, just denied approval for me to enter an FES program to try to stop the atrophy in my legs. This has been going on for over six months, and I am tired of the dueling with words. They said that because I am a totally flaccid complete para that the FES will not help. I even submitted all my rehab reports which showed the rapidly progressing atrophy. When I was first admitted my calves were 16 ½" in diameter, and my thighs were 20 ¾" in diameter. My calves are now 10" and my thighs 13 ½ ... stork legs. I guess it is what it is........so much for my future of wearing shorts, dresses, and skirts. Bring on the jeans ! SCI more than sucks.

marmalady · 12-02-2003, 12:21 PM

Hi, Laura

Have you been filing yourself for your bike? Please look here for a topic you may find of interest in the 'Exercise' forum:

here

_____________
Tough times don't last - tough people do.

Liz321 · 12-02-2003, 01:44 PM

did you have a good medical justification?

appeal.

Curt Leatherbee · 12-02-2003, 02:00 PM

What level and Asia score are you? No doubt it is hard to get these covered. You may want to check with your State Voc Rehab, in some states they will pay for these bikes. I see you are in Ohio, that is the state both FES bike Manufactures are located in. Last question have you had a needle pulse stim test done to see if the muscles contracted when there is current applied? If they do not contract during this test it means a FES bike will not work for you as you are flaccid so therefore it would be a waste of money.

"Life is about how you
respond to not only the
challenges you're dealt but
the challenges you seek...If
you have no goals, no
mountains to climb, your
soul dies".~Liz Fordred

laura26 · 12-02-2003, 02:03 PM

Liz- I thought I did...it was done by the FES Ctr.. I assumed they know what they are doing....

M.Lady - Thanks for the info...I was talking about an FES program at the Cleveland FES Center, but maybe this is another avenue that I can pursue. However, I am so bummed out, that at the moment I don't want to try anything anymore. There are mixed opinions as to if it would do anything for me, and naturally the insurance took the side that benefits them, not me, as they always do....

Liz321 · 12-02-2003, 02:10 PM

Don't give p. You'll learn some valuable lessons.

laura26 · 12-02-2003, 04:05 PM

Curt - I don't know what an ASIA score is, or needle pulse stim. But here is what is on my medical papers:
"T-12 A , flaccid paraplegia with vascular occlusion of lumbar cord segments 2-4 "
As far as the FES, they did run some tests. They placed pads on various points, and had trouble finding the right settings to get a reading. They then brought in another machine that had really fine needles on the ends of the wires.They inserted the needles into my legs at various places. After a lot of different impulse settings, they found one that caused a little twitch in my thigh muscle every time they pushed the button. They then tested the both calf muscles and managed to get the same type of twitch, but it would only do that for 3-4 times, then nothing. After about 20-30 min of resting, it would twitch again but then stop. I do know that the settings were some kind of high frequency something...sorry, I really don't understand that kind of stuff.
They felt that after 2-3 weeks of stimulation that they may be able to get the muscles to partially contract. Does this sound right? Am I just wasting my time with all this?

PB72181 · 12-02-2003, 04:20 PM

You're an ASIA A, then.

Don't piss me off or I'll run over your toes.

Curt Leatherbee · 12-02-2003, 06:02 PM

Unfortunetely I would have to say that perhaps the insurance company is right in this case that a FES bike would not benefit you very much. There are advantages and disadvantages to being a lower level injury such as yourself, the main disadvantage is the intense muscle atrophy that takes place as there is no reflex arc. The Advantage is you have more function than a higher level would.

"Life is about how you
respond to not only the
challenges you're dealt but
the challenges you seek...If
you have no goals, no
mountains to climb, your
soul dies".~Liz Fordred

sue123 · 12-02-2003, 09:13 PM

Laura'
Hi, I'm kinda new here, I don't know all your circumstances, except that your T/11 sci, right? Anyway I am T11/12 and 7 years ago (when I worked for G.E) we had really good insurance between my husband and I but I couldn't get approved by either of them,( at that time my main concernes were for atrophy which was really bad and I have severe osteoporosis also) but it didn't matter they would not approve me.I ended up buying an EX-n-Flex ( peddling system that does the peddeling for you) Looking back on everything if I could go back I would have focused more on standing.why don't you look into getting a standing frame or a mobil standing chair? Just a suggestion from a long time SCI survivor.Whose bone denstity is off the charts for having no stress on my bones
Oh Yeah, I used the F.E.S bike years ago, because of my low injury it didn't work to help me peddle,these thing are very expensive but look around and see if there is an Independant living center that might be able to help you, Good Luck

12-02-2003, 11:55 AM	#1
laura26 Junior Member Join Date: Oct 2002 Location: Ohio,USA Posts: 26	Turned down for FES Well...my insurance company, BC-BS, just denied approval for me to enter an FES program to try to stop the atrophy in my legs. This has been going on for over six months, and I am tired of the dueling with words. They said that because I am a totally flaccid complete para that the FES will not help. I even submitted all my rehab reports which showed the rapidly progressing atrophy. When I was first admitted my calves were 16 ½" in diameter, and my thighs were 20 ¾" in diameter. My calves are now 10" and my thighs 13 ½ ... stork legs. I guess it is what it is........so much for my future of wearing shorts, dresses, and skirts. Bring on the jeans ! SCI more than sucks.

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12-02-2003, 12:21 PM	#2
marmalady Senior Member Join Date: Aug 2001 Posts: 3,988	Hi, Laura Have you been filing yourself for your bike? Please look here for a topic you may find of interest in the 'Exercise' forum: here _____________ Tough times don't last - tough people do.

12-02-2003, 01:44 PM	#3
Liz321 Senior Member Join Date: Jan 2003 Location: NY Posts: 5,582	did you have a good medical justification? appeal.

12-02-2003, 02:00 PM	#4
Curt Leatherbee Moderator Join Date: Jul 2001 Location: Florida Posts: 9,308	What level and Asia score are you? No doubt it is hard to get these covered. You may want to check with your State Voc Rehab, in some states they will pay for these bikes. I see you are in Ohio, that is the state both FES bike Manufactures are located in. Last question have you had a needle pulse stim test done to see if the muscles contracted when there is current applied? If they do not contract during this test it means a FES bike will not work for you as you are flaccid so therefore it would be a waste of money. "Life is about how you respond to not only the challenges you're dealt but the challenges you seek...If you have no goals, no mountains to climb, your soul dies".~Liz Fordred

12-02-2003, 02:03 PM	#5
laura26 Junior Member Join Date: Oct 2002 Location: Ohio,USA Posts: 26	Liz- I thought I did...it was done by the FES Ctr.. I assumed they know what they are doing.... M.Lady - Thanks for the info...I was talking about an FES program at the Cleveland FES Center, but maybe this is another avenue that I can pursue. However, I am so bummed out, that at the moment I don't want to try anything anymore. There are mixed opinions as to if it would do anything for me, and naturally the insurance took the side that benefits them, not me, as they always do....

12-02-2003, 02:10 PM	#6
Liz321 Senior Member Join Date: Jan 2003 Location: NY Posts: 5,582	Don't give p. You'll learn some valuable lessons.

12-02-2003, 04:05 PM	#7
laura26 Junior Member Join Date: Oct 2002 Location: Ohio,USA Posts: 26	Curt - I don't know what an ASIA score is, or needle pulse stim. But here is what is on my medical papers: "T-12 A , flaccid paraplegia with vascular occlusion of lumbar cord segments 2-4 " As far as the FES, they did run some tests. They placed pads on various points, and had trouble finding the right settings to get a reading. They then brought in another machine that had really fine needles on the ends of the wires.They inserted the needles into my legs at various places. After a lot of different impulse settings, they found one that caused a little twitch in my thigh muscle every time they pushed the button. They then tested the both calf muscles and managed to get the same type of twitch, but it would only do that for 3-4 times, then nothing. After about 20-30 min of resting, it would twitch again but then stop. I do know that the settings were some kind of high frequency something...sorry, I really don't understand that kind of stuff. They felt that after 2-3 weeks of stimulation that they may be able to get the muscles to partially contract. Does this sound right? Am I just wasting my time with all this?

12-02-2003, 04:20 PM	#8
PB72181 Senior Member Join Date: Nov 2003 Location: Ohio Posts: 454	You're an ASIA A, then. Don't piss me off or I'll run over your toes.

12-02-2003, 06:02 PM	#9
Curt Leatherbee Moderator Join Date: Jul 2001 Location: Florida Posts: 9,308	Unfortunetely I would have to say that perhaps the insurance company is right in this case that a FES bike would not benefit you very much. There are advantages and disadvantages to being a lower level injury such as yourself, the main disadvantage is the intense muscle atrophy that takes place as there is no reflex arc. The Advantage is you have more function than a higher level would. "Life is about how you respond to not only the challenges you're dealt but the challenges you seek...If you have no goals, no mountains to climb, your soul dies".~Liz Fordred

12-02-2003, 09:13 PM	#10
sue123 Junior Member Join Date: Oct 2003 Posts: 3	Laura' Hi, I'm kinda new here, I don't know all your circumstances, except that your T/11 sci, right? Anyway I am T11/12 and 7 years ago (when I worked for G.E) we had really good insurance between my husband and I but I couldn't get approved by either of them,( at that time my main concernes were for atrophy which was really bad and I have severe osteoporosis also) but it didn't matter they would not approve me.I ended up buying an EX-n-Flex ( peddling system that does the peddeling for you) Looking back on everything if I could go back I would have focused more on standing.why don't you look into getting a standing frame or a mobil standing chair? Just a suggestion from a long time SCI survivor.Whose bone denstity is off the charts for having no stress on my bones Oh Yeah, I used the F.E.S bike years ago, because of my low injury it didn't work to help me peddle,these thing are very expensive but look around and see if there is an Independant living center that might be able to help you, Good Luck