Frusteration with Insurance co.

[jmartinez1895]

First let me say that I am very thankful to have insurance and hope that we will always have it.
I guess I just need to vent a little. My son has many neurological issues. One of his most recent issues is that after walking for a while he will have a sudden migraine and then a drop seizure. He is 8, but very small ( 44 inches tall and 39 lbs.) He is getting a little to big to ride in his stroller for long periods and be comfy so the doctor tried to get the insurance to pay for either a special needs stroller or a wheelchair. They will not cover it. They said that for our plan to cover one he would have to have a muscle or bone malformation. The only neurological coverage for one is a stroke that hinders one immobile. They also said that a chair for our purposes would be preventative. I know that there are many people with worse issues, but when your child can not walk around walmart without crying in sever pain and then having a seizure you feel like you are at your ropes end. I looked at ebay and other places, but even used ones are way out of our price range.
We have tried every angle with the insurance co and there is no way they are going to help. Does anyone have any ideas? I am just so frustrated.

 

[alizesmom]

You can appeal the decision. Instead of just getting an order, you need a letter of medical necessity explaining why a wheelchair is needed. If your son goes to PT or OT they should be able to hep you with this. Good luck. Karen

 

[jmartinez1895]

The doctor sent a letter of medical necessity and that is when they told us that his diagnosis does not qualify

 

[mdvlprof]

Ahhh, the joys of bureaucracy.

Can dr write with a different diagnosis. If he can't do WalMart w/o screaming in pain, sounds like muscles/tendons are involved? Have they become malformed...even a teeny bit?

 

[LoveMickeyWaffles]

It always amazes me the things insurance will and will not cover and they're reasons for denying coverage are ridiculous - as if they know better then the doctor!

Coverage was denied for my sons first special needs stroller. My son has a trach tube and is mobile (but has an awkward gait) and tires quickly because of his breathing issues. Finally, after filing an appeal and waiting several months, they finally granted coverage. You just have to be persistant!

You could also try contacting Variety Club. I don't think there is one in Alabama but you could contact the HQ in Los Angles (?) and they could probably point you in the right direction.

 

[jmartinez1895]

Thanks all, I will try that and I'll talk to one of his doctors about having his muscles and tendons check out. His main issues are neurological. We had to fight them to get them to cover his home oxygen they finally did, but that was months of hassle ( well worth it, but lots of headaches). I just can't stand the fact that someone sitting behind a desk that has never seen my child can make a decision that oveer rides what his doctors think, but as I said I am very very thankful for the coverage that we do have and we would be in a world of trouble without it. Sorry I got on my soap box again....anyway, thanks for the support.

 

[Piper]

I am so with you. It is a shame that you are having to go through this.

(From someone who has been there and is back again--done that and is doing it again)

 

[hambirg]

Does he need just a basic, fold up style wheelchair?

If that's the case, you can find them on Craigslist. A quick search for my area brings up many and some for as little as $20. If he sees a PT and/or OT get some input as to size and features that will work best for him though.

ETA-Wheelchair Foundation is an organization that might be able to help you out.

http://www.wheelchairfoundation.org/

Also, Joni and Friends might be able to help you.

http://www.wheelchairfoundation.org/

 

[bookwormde]

Get letters of medical neccessity from multiple clinicians

I can tell you that keep working on it. Insurance companies hate it when denial of benefits involving a child become "public" so do not be afraid to use that angle.

bookwormde

 

[jmartinez1895]

Thanks for the links. I have made appointments with some of his other doctors. I guess I'll start a collection of letters and keep sending them.

 

[LMC]

I sent you a PM.