Private Wheelchair insurance
There is a tendency to vilify insurance companies rightfully so in some cases but keep in mind that, in order to keep your premiums low and stay in business, insurers must control the costs of what they provide to you and other policy holders. You will be looking to get what you need so that you can live a full and comfortable life; your insurance company will be looking to place limits on what you get. Insurers also need to guard against the possibility that an unscrupulous lightweight wheelchair vendor might try to charge unnecessarily high prices in the belief that the "rich insurance company" has deep pockets. Although you may have to assert yourself to get the right wheelchair, it's possible that approval from your insurance company will go smoothly. If your policy covers a wheelchair, the need for the prescribed chair is clear, and your vendor states a fair price, your insurance carrier might pay with little or no resistance. Don't assume your insurance policy won't cover something you need. It's worth the effort to check your policy or discuss your situation with your insurance contact person. For example, insurers might well be willing to cover the cost of a new chair assuming you have a justifiable medical need. Increasingly, private health coverage is being provided by managed care organizations rather than traditional insurance companies. Managed care organizations are extremely cost conscious. Some clients are finding it difficult to convince their HMO or PPO to buy them the wheelchair they really need. The ease with which you will be able to get the optimal chair for you depends on the fine print in the managed care plan, so before you enroll in such a program, be certain to understand their spending policies. Jody Greenhalgh, of UCSF/Stanford Rehabilitation Services, has found that it is more difficult to get payment for more sophisticated chairs and positioning systems under managed care. If you already belong to a managed care plan, and they refuse to provide you with the chair you need, there are a number of things you can do to get your plan administrator to reconsider. First, ask your doctor or therapist to write a letter explaining why specific options are medically necessary. If they are unable to convince the administrator that a particular chair is essential for your health, you can appeal the decision. Most, if not all, HMOs and PPOs have a procedure for appeals and are required to give you information about how it works. Depending on your situation, you can persist further by enlisting the help of your employer's benefits department (if the coverage is employer-provided), writing to the state insurance commissioner, contacting an appropriate advocacy group, or appealing to your congressional representatives. |
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