This really didn't suprise me

[AKmom]

Warning! This is a rant. A release of my frustration how insurance companies have continually through the years have dictated and thwarted the plans of my doctors and me for getting what I need to survive as a productive person on this earth!

It doesn't suprise me that after all the hoops my doc and I jumped through to get me a decent pwc to help me be in less pain and more independent, that some peon sitting behind a desk just shines us all on and rejects the pre-certification because "we don't have proof that your current pwc cannot be upgraded or repaired". What a bunch of crock! The seating clinic that the insurance sent me to should be proof enough when they stated my current chair could not meet the needs of my progressing desease. The current chair I have was bought 4 and a half years ago and is a cheap travel pwc that was meant for getting me around airports and any other place that I was too fatigued and weak to walk. I was still walking quite a bit back then with fore arm crutches. Now I am in the chair 100% outside the house. The chair has been drug across tarmacks several times and have several flat spots on the wheels, to the point that it goes thumpity thump all the time. Painful on the hip. The chair also has always had a problem with building up a static charge in airports, hotels, cruiseships and malls that have certain kind of flooring. I zap others or I get zapped good. At times, just by me pointing at an elevator button, a discharge will go between my finger to the button and open the door with me not even touching the elevator button. Then there are issues with the cable to the battery has come off the cheap broken down bracket and this has caused the cord to the controller to become disconnected at various times. Quite the annoyance. The chair does not have a big enough seat for me and it does not have anyway I can elevated my legs. This chair was not meant to sit in all day!

I do not have the time or patients to fight with stupid insurance anymore! I just went ahead and ordered my own chair without their approval. A Jazzy 14 with elevating legs will do just fine. It may not have all the fancy tilting options that the seating clinic was trying to push though, but it is half the price had I bought it through the drugstore that the insurance said I had to buy through! (Which isnabout the amount I would have paid if insurance did buy it).

I am so holding back on my thoughts of the current p o l i t i c a l issues going on with insurance, but I hate it.

It sucks enough having PLS. We should not have to be subject to peon rejections!

 

[Port]

I certainly can agree with you. Nothing aggravates me more than jumping through insurance hoops only to be denied by some youngster behind a desk who a: knows nothing about your situation. B: has never been sick. C: gets all his experience from a rulebook. I work for a company where we get a 400.00 break on our insurance benefits by signing up with a health coaching service and meeting health goals set for us by a 20 year old kid. I just pay the 400.00 rather than have to explain to the kid that I do not give up walking by choice. Itis a life event forced upon me. I in fact loved to walk and find the chair quite a hinderance. Sorry.....now I'm ranting.

 

[vzandt]

So totally agree. Doctor wants a trilogy. Insurance Says no. Really? Really? Why? It's not like people want them because they decorate the house nicely.

 

[AKmom]

Boy, rereading this after a couple days and me settled down, I was pretty upset when I wrote it. Thanks for your understanding and no problems with your rants either. This issue has been a thorn for quite some time, but I just had enough to explode. My poor hubby got an ear full when he got home from work as he was wanting me to fight it and continue with the process. I have already been waiting over a year. What gets me is the insurance did not pay for the first chair at all, so they should not have had that even as a consideration in their accepting or denying of a new chair.

Anyway, I am glad others can relate to my frustration, but am sad that anyone has to go through this frustration.

 

[olly]

Sorry to hear your troubles Joyce,personally I would have challenged it and asked it be reviewed.
I got a new scooter last year but will be getting a chair in 2yrs time ....this is paid for through my mobility money and you can have new every 3 years. (((hugs)))

 

[gooseberry]

I can tell you that while the trilogy works well for my husband, our copay for a cough assist, a night time trilogy, and a sip and puff is $4300 a month. The dme copays/coinsurance are incredible. My insurance brought our provider in network but the provider won't accept the $3000 they get from insurance each month as adequate. It is insane!

 

[AKmom]

Caroline, my new chair is already on its way here to Alaska. I figure that sometime in the future, I will need a chair that costs quite a bit more than the just under $4000 price tag I just shelled out for this next step up chair. When that future date comes, I will need the insurance to cover it, because that chair will be needed to help me stand and pivot back to find the right positions for comfort. The Pride Jazzy Elite 14 I am getting now will have the elevating leg rests and a bigger seat that reclines somewhat, but not like a perimoble. I will fight them then, as that might be in less than the 5 year timeline of what they consider when replacing a chair. Since they didn't pay for this one, they do not know anything about it, so if the time comes that I need a fully powered, expensive chair, I will have some fighting power to justify them paying for it. As it was, the seating clinic was trying to get me a more upgraded chair then what is needed at present time. Had it not been rejected, we would have paid about the amount I have paid for this new chair myself, as our copay.