DerbyCity Area Chapter of the National Spinal Cord Injury Association
ABOUT THE ORGANIZATION
The Derby City Area Chapter of the N.S.C.I.A. is a membership organization for individuals with spinal cord injuries, their families, and health professionals. Founded in 1984 as a Charter Member of the N.S.C.I.A., it was incorporated under IRS Section 501 (c) 3 as a not for profit organization. The Board of Directors consists of the Officers, Past President and the Board Members At Large.
*** OFFICERS
PRESIDENT
David Allgood - (502) 589-6620
VICE PRESIDENT
Adam Ford - (502) 425-2206
TREASURER
Tom Stokes- (502) 957-5865
LIAISON TO FRAZIER INSTITUTE
Jill Farmer
FUNDRAISING CHAIR
Betty Perry—(502) 647-0368
CORRESPONDING SECRETARY/WEB MASTER
Michael Feger- (502) 647-0368
PAST PRESIDENT
Adam Ford- (502) 425-2206
BOARD MEMBERS AT LARGE-
Mike Perry
Kelly Young
NSCIA DERBY CITY CHAPTER NEWSLETTER
Editor- Barbara Davis
Contributor- David Allgood
Visit Our Website at www.DerbyCitySpinalCord.org
The Derby City Area Chapter Newsletter is brought to you through the generous support of Frazier Rehab Institute
GETTING EQUIPMENT HARDER, CONT’D
nearly four years, they sent me back to square one. The system is a joke, but it’s not funny.”
In December 2007 Freedman received another letter from Medicare stating that the iGLIDE would not be covered. “I’m getting worn down. If it were less money, I would just give up. I can’t tell you how many phone calls and letters I’ve sent, and you never get the same person. But I’m not giving up. It’s not only the money, it’s the principle. They keep telling me I’m entitled to reimbursement, but it’s going on four years, and I haven’t seen a dime.
On May 15, 2007, Sue Montgomery met with her local durable medical equipment dealer and ordered a Quickie Ti Ultralight as a replacement wheelchair. Six weeks later, Montgomery, of Knox, Pa., called and discovered that the person handling the paperwork had accidentally misplaced the paperwork, so it was re-sent. On July 17, Montgomery learned that her insurance company had denied her claim: the wheelchair was deemed “not a medical necessity.”
Montgomery, who has severe Bilateral osteoarthritis, had filed documentation of medical need by her orthoepidic surgeon along with her need as an active lifestyle wheelchair user with a full-time job. Her medical records established that she had undergone 11 failed reconstructive surgeries and had used a wheelchair for 15 years. Understandably upset, she appealed the Denial, which set in motion a series of appeals and denials—she appealed three times—until she finally received a letter of approval on October 9, followed by a shipment of the wheelchair on November 14. But the wheelchair that arrived had no brakes, no cushion, no anti-tip bars, and was the wrong size seat depth. Montgomery refused the chair. A different chair arrived on December 7 but still had the wrong seat depth. Finally, on January 4, 2008, the seat depth issue was solved. The list price on Montgomery’s Quickie Ti was nearly $5,700, definitely on the high side.
In her research, Montgomery discovered that had she been covered by Medicare (or if her private insurer would have allowed it), she might have been able to sign an Advanced Beneficiary Notice giving her the option of paying the difference between what the Medicare codes allow for a given type of wheelchair and the actual cost of the product.
Under an ABN, she would have been allowed $2,986, and she would have paid $2,641 out of pocket. However, Montgomery’s private insurance did not allow an ABN (see www.wheelchairjunkie.com/abn.html for an article on ABNs). Fortunately, since Montgomery won her appeal on the third try, she got a much better deal, paying only an out-of-pocket deductible of a few hundred dollars. Although the overall purchase price was high, her portion was minimal. Not all insurance companies would have covered as much.
