So there has been a lot of interest about how I was able to get my Bioness
covered by insurance. I thought you might be interested in seeing the
videos that my case worker used.
In the first video (where I have the cane) I'm not wearing braces or anything just walking under my own power.
In the video with the Bioness (the one where I am wearing the orange shirt), that was the first day I used it! I think there was only a few days between the videos.
These are the only videos my case worker used with the insurance company. I also wrote a letter (yes it was a sappy letter) to the head of the insurance company. Does anyone have advice for getting an electronic stimulus device approved that they could share?
In order to get my electronic foot drop system I was going to have to come up with $6,500, considering that I am a rich and famous teacher (I wish) that should be no sweat. Dianne the rep I was working with from Bioness told me that there was a chance insurance may cover the device if I could prove medical necessity. So I set out to see what I could do.
Rewind a few months back to the beginning of summer 2013, for some reason my insurance stopped covering my Tysabri infusions. I called the 1-800 number on the back of my insurance card to try to get to the bottom of things, after an hour of explaining things to employee after employee I was no closer to getting an answer to my problem. Frustrated and Tysabriless I did what anyone would do, I complained to a co-worker. Luckily it was the right co-worker, she informed me of an option that was available in my insurance to get a case worker to help me manage my health care.
After getting set up with my case worker Therese I explained the issue about my infusions getting cut off and she went to work. Turns out somewhere along the line someone had entered a code wrong causing my meds to become unavailable to me. There was no way I could have fixed this problem on my own; it took an hour on a conference call between 6 people to right the ship! Anyway Therese to the rescue and I was back in business.
Back to the electronic foot drop device, after demo-ing it for a short time there was no way I was going without it, it looked like I was going to be in the fundraising business. After talking with Therese my case worker she told me that I should be taking video of my PT appointments for documenting purposes. So along with Mary my PT we started to record my walking each trip I took to the office.
Therese told me to get a letter of necessity from any and all Dr.’s that I dealt with and she would present my case to the board of decision makers. I collected letters from every doctor on my team, I felt like a pest but finally I had all of the needed documentation. All that was left was for Therese to present my case to the board, this was a very nerve racking time for me, all I could do was sit around and wait for the news.
Finally I received a call from a director at the insurance company and they had agreed to cover me! “It was the videos that really did it”. I couldn’t believe it, I was covered, I never thought it would work out. “We’ll cover $80” is what I expected but it all worked out and they covered the whole amount! I owe Therese for all of the hard work she put in to get this through.
If I could do it maybe you can do it too, ask questions find out what is available through your insurance. If not through your insurance throw a fundraiser, people would rather donate to help out a friend anyway. Be your own advocate and never stop fighting.
Be a Warrior Today,
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