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  • Writer's pictureNadya Tahri

Insurance Did It Again

Today I wanted to share about the fact that insurance just denied Isaiah another piece of equipment.

Yep again!

So about a year and a half ago basically Isaiah’s physical therapist and I had requested that the insurance cover a hospital bed

for Isaiah and a tomato chair and his insurance denied it and then Isaiah's physical therapist changed the wording and then resubmitted the request to the insurance again.

But the insurance denied it again.

Then Isaiah's primary doctor actually called and talked to Isaiah’s insurance and said why this was really necessary...

Isaiah's doctor explained to the insurance that Isaiah chokes at night and he has to be elevated and we were just using pillows to prop Isaiah up at night.

So anyways, after that third denial from the insurance then I asked the physical therapist what can we do and she was saying pretty much that the only thing you can do at this point is to file an appeal.

So that's what I did…

but the thing is, from what I understand from talking with a lot of parents who have a child with special needs…..

Well the fact is that insurance denies a lot of equipment because either they're not really paying attention to what the child actually legitimately needs or maybe it's about saving money.

I'm not really sure.

All I know is that it's common for insurance to deny equipment that children who have special needs really Do need.

It's not just happening to us, I know that this is happening to other families who have a child with special needs.

It’s really sad to me that insurance companies make it SO difficult to approve equipment that these kids really need!

So I filed the appeal and then we had the phone call with the judge (this is all during covid) and basically we had an appointment date set for the real hearing.

This phone call that I had with the judge and with the insurance company was kind of almost the preliminary to get things set up and to figure out a date that would work good for everyone to have the official court hearing.

So we got the date set up for when we would have the official court hearing.

Then about a week or two after that initial phone call that I had with the judge and with the insurance company, I couldn’t believe what happened next.

The insurance company contacted me and said “So we discussed it and we decided that we will pay for Isaiah's hospital bed but we won't pay for the tomato chair.

Tomato Chair that Isaiah needed

And I was like “We need the tomato chair just as much I mean he needs it.”

So what they wanted me to do was they wanted me to withdraw the court hearing and I said that I would not withdraw the court hearing unless they agreed to pay for both the hospital bed as well as the tomato chair.

I think that they thought that I would be happy if they had agreed to pay the hospital bed and just feel like “Oh thank you so much!” And that I would just call it good because honestly the hospital bed is super expensive and the tomato chair I think is maybe around seven hundred but it's not like thousands and thousands of dollars.

But I thought “Why should I settle? I mean Isaiah needs Both of them.

There is medical necessity for both the hospital bed as well as the tomato chair.

So I said “No”.

“If you want to pay for both then I would be happy to contact the court and withdraw from the case and you know close the court hearing but if you are only going to agree to pay for the hospital bed then then I'll see you in court.”

I mean I don't want to be nasty and I don't want to argue but legitimately there's no reason why they shouldn't cover both of these things so long story short they ended up coming back and they ended up saying

“Okay we will pay for both.”

And that is exactly what ended up happening.

They ended up actually paying for both Isaiah's hospital bed And his tomato chair.

And I was really happy.

Isaiah already has a bath chair and he also has an eye gaze device so you know so he can communicate.

So I was feeling pretty good like we have everything we need.

I mean we still need a wheelchair van but aside from that I was thinking were pretty good.

So I was happy but then a different physical therapist down in Portland at Doernbecher Children's Hospital suggested that we try to get Isaiah a power wheelchair because you know his brain works right and it's just that his muscles don't work right and so we brought Isaiah in for several appointments and they had Isaiah like they tested him basically saying “Isaiah make the wheelchair go to the window” or “Isaiah run this over” and they put like a styrofoam thing that he could run over.

They also said “Okay Isaiah, make the wheelchair go to the right make it go to the left”

so they were basically making sure that he understood directions and that he understood how to work the power wheelchair and we got lots of video.

So we got both pictures as well as video of Isaiah operating the power wheelchair all by himself.

He did an excellent job! And I am SOO, SOO proud of him!

We went in for three or four sessions where he was demonstrating that he could work this power wheelchair then the physical therapist submitted it to the insurance and then the insurance had a guy that came out to our house because insurance will not cover it if you don't have a wheelchair accessible home right?

It's like if you have a bunch of stairs just to get to the front door of your house, then there's no way that a child could realistically use it….as a child with special know…..using a power wheelchair.

If the house has stairs then the insurance is not going to cover it.

So the guy came out to our house. He did the whole assessment and walked all around our house.

He realized that our house is 100% wheelchair-friendly there are…

no steps…

no stairs…

Our whole house is totally wheelchair ramp friendly and so then after the guy came to our house and did the assessment he then wrote his little report you know that he thought everything was good to go and then insurance denied it!

And I was like “What the heck!?”

“I wonder why they denied it because I feel like we had ample proof that…

#1.) Isaiah could work the power wheelchair perfectly fine!

#2.) Our house was/IS fully accommodating for a wheelchair.

So anyways I was just surprised that insurance denied it.

Now I will say that a power wheelchair is super super expensive... like it would be the most expensive thing that we would have ever gotten for Isaiah and so I understand that with higher cost that there is definitely going to be harder to get an approval from the insurance, but anyways I will keep you updated with the power wheelchair.

I'm going to go ahead and ask that the physical therapist request it again and I will just go through the same process that I just told you where we try to reword it and see if we can request it to insurance using different words and then I'll have Isaiah's primary doctor talk with the insurance company and try to say how this would really be helpful for Isaiah because it really would be super helpful!

It would give him so much more freedom because he would have the ability to move about in the house on his own without basically being stuck waiting for one of us to wheel him where he needs to go.

I mean it's just the more freedom obviously that you can give your child who has special needs obviously the better!

And since he has the brainpower to work the power wheelchair, I just don't see any reason to not pursue insurance to cover it.

So if I have to file an appeal I will but I basically just wanted to share what was going on.

So I am super curious to know….

Have you ever had a piece of equipment denied from insurance….that your child with special needs really needed?

And if so, what did you do?

I would love to hear from you!

~ If you are a parent of a child with special needs, I would Love to have you join my private FB group. It is a safe environment, strictly for parents who have a child with special needs, where you can get encouragement and support from other parents who can relate to what you are going through. The name of my private FB group is called “Special Needs Parenting SOS.” ~ 😇💕

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