Jim,
Congrats on your huge victory! You should share your letter so we can all
follow your lead.
Good luck with the chair.
Paul c5/6
----- Original Message -----
From: [EMAIL PROTECTED]
To: quad-list@eskimo.com
Sent: Saturday, January 05, 2008 7:49 AM
Subject: [QUAD-L] wheelchair denials/approvals
Since the summer of 2005 I have been in the process of trying to qualify for
an Omega Trac wheelchair. I had to try different manufacturers front and
mid-wheel drive (I have a rear wheel drive) chairs and explain why they would
not suit my needs to Medicare, medical assistance and Blue Cross Blue Shield.
After being denied by all three because they said it was not "medically
necessary" to have such an expensive share I started my appeal process. I
wrote a five-page appeal letter, with pictures and was surprised that Blue
Cross Blue Shield had reversed their decision because of my compelling appeal
letter and approved the Omega Trac chair for me. On New Year's Day, my son
went down and got the mail from New Year's Eve and there was a letter in there
from medical assistance. The letter went on for two paragraphs explaining why
they feel that this chair was not medically necessary for me. The third
paragraph then stated why they would approve the chair and pick up the
out-of-pocket costs that I would need to pay if I just went with Blue Cross
Blue Shield. I read that last paragraph several times and was absolutely
flabbergasted that medical assistance changed their minds. If it wasn't for
Kiersten from National Seating & Mobility, I do not think that this would have
happened. The Omega Trac should be ordered next week but I'm really not going
to believe it until I'm sitting in it because you never know what can happen.
Yesterday, Friday, I received a call from the appeals judge confirming that
medical assistance reversed their decision and approved my chair. She is going
to sign all the legal documents and send me a copy.
For those of you that are wondering why I went with such a large chair like
the Omega Trac here's my reasons. I live in the country near Duluth, MN which
is hilly and not very conducive to standard wheelchairs especially in the
wintertime. I'm a large man that likes the stability of the Omega Trac
compared to my Invacare especially when transversing hills and uneven ground.
I need a solid platform for driving around the hills of Duluth and I own my own
home in the country and have been stuck to many times in my driveway during and
after a snow along with not being able to go in my yard unless somebody is with
me.
The bottom line is freedom.
I guess the moral of the story is to find the company that you feel
comfortable dealing with and also never take no for an answer until all avenues
and appeals are exhausted. Carefully read all documentation and make sure all
your I's and T's are dotted and crossed.
Jim
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Start the year off right. Easy ways to stay in shape in the new year.
