The Derby City Chapter of the National Spinal Cord Injury Association Network- Serving Kentuckiana.
Message From the President
Dear Members & Friends-
THERE WILL NOT BE A MEETING IN JULY.
August’s meeting will be held at Frazier Institute, 220 Abraham Flexner Way, 10th floor dining room, Louisville.
- David Allgood
From New Mobility com GETTING EQUIPMENT GETS HARDER
By Tim Gilmer
Wheelchair users are finding out that getting the durable medical equipment they need—and getting it when they need it—is getting harder and costlier. Restrictive documentation policies as well as outdated “in-the-home” language that governs claims decisions in the Centers for Medicare and Medicaid Services are creating hassles for DME dealers and consumers. What’s worse, power wheelchair reimbursements made by Medicare—already reduced by 27 percent in January 2007, will be reduced by another 19 percent on July 1 due to Medicare’s national competitive bidding program. Since private insurance companies follow CMS’ lead, these new policies portend a growing nightmare of denials, delays, red tape, and economic hardship for DME dealers and users alike.
When Abbie Freedman, of Santa Rosa, Calif., was paralyzed at age 39 due to a T5 spinal cord injury, she was immediately covered by MediCal. A year and a half later, because MediCal does not allow anything more than subsistence funds in the bank, she was switched to Medicare. She used three wheelchairs in the next 22 years, and Medicare picked up the costs. Now in her early 60’s, with deteriorating shoulders, Freedman was advised to have corrective surgery, but her personal physician, knowing how difficult recovery can be, advised against it. Instead, he prescribed specialized therapy and a new power wheelchair.
Freedman ordered an iGLIDE, manufactured by Independence Technology, and was told by IT that Medicare would cover it. Anxious to get on with saving her shoulders, she paid for it out of her own pocket, then filed a claim for reimbursement for Medicare. She received the chair in September 2004 but was surprised when her claim for reimbursement was denied. “I’m not sure I would have ordered it had I known Medicare wouldn’t pay,” she says. “$6,230 is a lot of money.”
The Medicare Denial stated: “This item cannot be paid without a new, revised, or renewed certificate of medical necessity.” Freedman then resubmitted a new CMN and her appeal was approved in March 2005, but no reimbursement was issued. Later she received a letter dated June 28, 2005 from a Medicare administrator in response to her appeal, stating, “If you paid any amount to this provider for this service, Medicare will pay you back the amount you paid. To get this payment, bring or send to this office three things: 1. A copy of this notice; 2. Your supplier’s bill; 3. A receipt or other proof that you have paid this bill.” “At that time, I submitted the three required documents,” says Freedman. “Since then, I have made several attempts to get this reimbursement from Medicare, both written and by phone, only to get a runaround, no response, or one that is irrelevant,” she says.
The latest runaround occurred in August 2007, when she was told by CMS that she would receive reimbursement by CMS’ contracted carrier—Noridian Administrative Services, of argo, N.D., but she would have to contact them directly. She did, and was told she had to fill out another form. “It was an original claim form! After
