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Subject: Testamonials - Please help me out

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terhorstj
Posts:12

09/14/2006 2:10 PM Alert 

Hi everybody,

As I'm sure many of you are aware, I have been trying to get my insurance company (who claims to cover the Segway HT as medically necessary personal assistive mobility devices) to reimburse me for my Segway.  We are currently entering into an appeals process and I am trying to collect documentation regarding scientific, social, and most importantly, medical, impact of the Segway on the lives of those with disabilities.

I would like to ask anybody who would feel comfortable volunteering their stories or testimonials here to please do so.  I am an AVM (stroke) victim who has nerve damage at the brain stem / spinal cord, and so stories of that nature would necessarily be most poignant. Also, if you happen to have any supplemental material regarding this (clinical studies, medical journal communications, etc), please post those here, link them, or e-mail me (my address is given below).

If you would feel more comfortable e-mailing me instead of posting here, you may do so.  My e-mail address is terhorstj@gmail.com.  I will keep all submissions anonymous!

 

Thank you all,

Sincerely,

John

 

jimbo74
Posts:41

09/23/2006 10:18 AM Alert 
John,

What is the status of your appeals situation?

Jimbo
terhorstj
Posts:12

09/23/2006 12:01 PM Alert 
We're actually still waiting to hear from insurance about the details of why my claim was denied. John
terhorstj
Posts:12

09/23/2006 7:41 PM Alert 
We got the denial paper. They specifically referred me to this item in their General Exclusions list: “Over the counter Equipment for non-prescription [over the counter] medical equipment or supplies that can be purchased without a licensed provider’s prescription order, even if licensed provider writes a prescription order for a non-prescription item, except as specifically provided in the Evidence of Coverage.” I’m not sure what that means; we will call the broker on Monday. It seems to me, that the best evidence we have is the document where the Segway was listed as DME... More info later...
jimbo74
Posts:41

09/26/2006 10:37 AM Alert 
John,

You seem to be proceeding in the appropriate manner, and even though we do not know of anyone who has gotten reimbursed for a Segway as a mobility aid YET, whatever you are able to accomplish (even partial) will benefit all of us. It's all in the wording, and of course they wrote it to save the company the most money, so your job is to penetrate their "armor" with words as well. The key words  are DME and now "evidence of coverage" so these need to be defined in further detail as you see them in your full insurance coverage paperwork. As I stated in another forum, DME for a Medicare beneficiary has 4 statements to be considered such. The one that states it "must be a device or equipment that was designed for and is used primarily for medical treatment or injury" (from memory so may differ some) is the one that kills it for me as the Segway does not fit this and is therefore excluded. (there is a code for "other" in the POV PMD DEMERC "book" but it is not reimburseable) From what I've read in the posts it seems your insurance policy is considered liberal (where as Medicare is very conservative/restrictive) (they haven't even approved the "IBOT" yet) so you may have a chance of some reimbusement if you keep at it and follow appeals guidelines in a professional manner and with adequate support documentation. (I feel the DRAFT testimonial to the Parks Commission to be invaluable as regards the aspects of the Segway which places it in a unique "niche" mobility category as well as providing testimonials of real people who use them for this purpose)

When you say "broker" who exactly is this and are they solidly motivated to help you all the way with this? If not,, you'll need to find someone who knows more about this than you yourself to be your advocate,, perhaps an attorney skilled in reading insurance policies whom you could pay hourly for interperetation and advice as to specific steps which would best move you forward. You would only need this in limited time periods and can handle the actual appeals process (time-paperwork) yourself.

I'll be following along with ya!

Jimbo
segmental
Posts:18

10/08/2006 10:10 PM Alert 

I too am in the process of getting medical insurance to reimburse for a Segway (with seat too!).  As predicted, the first response is a denial as not convered, because it is a "convenience".  I totally agree that it's most convenient not to keep breaking my foot and leg bones by using the Segway instead of pounding on them in daily walking.  That of couse, doesn't answer, for me, the question whether it's "medically necessary."    I've requested that my doctor send more documentation. 

I have an idea, prompted by terhorstj's request for testimonials.  I will be at Segfest with videocam on shoulder.  I was thinking we could capture you guys telling your stories on video--explaining how the Segway has improved your life --AND HEALTH!  With video we could show how you are able to maneuver on the Segway despite your underlying condition(s).

I'm thinking we could edit it onto a CD that we and others can use for education (the public, doctors, PTs, etc.) PR, and particularly to submit to insurance companies.   I think a video will get looked at more readily--and it's more powerful if we need to take this to the public for support. 

 

 

 

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