Back in September it was decided by my husband and me that my mobility is shaky at best, death defying at worst.
Onto the net I hop, where I can still be as active as any teen and no one knows that I’m really typing with only six fingers. Immediately I gravitate to scooters because they look cooler and give off a less disabled look than a powerchair. I see some mighty fine scooters that are easy to imagine beneath me. I feel the power. I feel the freedom. In my minds eye I see my teen dream of being a bad ass biker bitch with a smokin hog. Yeah.
So off to my physical therapist, Laurel B., to discuss options and solutions. I love my PT lady. She’s awesome, kind, considerate and has one of those personalities that makes you feel safe in a wholesome granola way. That was September 10ish.
She nixes the idea of a scooter. Crash. Heart plummet. Want! Can’t have. *sob*
All of her reasons for prefering a powerchair over a scooter are very valid. My shoulders screwy, it does take a little more cognitive and reflex action for a scooter versus a chair, with the numbness in my hands its harder to tell what they’re doing, etc. That and scooters have a bigger footprint than a chair. Scooters can’t be outfitted to recline, have head supports, leg rests, etc. OMFG am I going to need all that?!
We spent almost an entire hour going over various options for a powerchair. And we could have kept going. This is not something a person should jump into without warning.
Laurel refered me to Clark at CareMedical. I like Clark, he’s in a chair and can answer questions honestly from an end user perspective, which is what I want. Its nice to hear what learned professionals THINK, it’s better to hear what someone whose been there KNOWS. In my never humble opinion of course.
Around October 4th we finally got down to CareMedical to talk to Clark. He had me try out some different chairs, take them for spins around the showroom floor (no joke). It was almost scary how quickly I got comfortable with it. Some of the chairs were simply too bulky. They made me feel fat. If you laughed at that you aren’t a woman.
On October 20th CareMedical delivered a ‘tester’ chair to the house for nearly a week. One word. YES. It took some doing to navigate around the house, and many area rugs were removed, but toward the end of the preview I was really getting accustomed to the power.
A word to the wise, be good at spackling or at least know someone who is. It takes some patience and time to get used to how ‘big’ you are when you’re in a chair.
I cannot explain the impact that had on me. I was clearer in the head (less fatigued), was in a better mood, wasn’t in as much pain and was more aware of ME. Anyone whose had chronic pain understands that last part. ‘Twas a sad day when they came and picked the chair back up.
Beginning of November the insurance sent us a courtesy letter asking for further justification.
A) Current chart notes/H&P/physical therapy evaluation or chart notes, if available documenting the member’s mobility status as well as physical capabilitiess, limitations, and strength testing of upper and lower extremities and the member’s endurance status.
B) How many feet, if any is the member able to ambulate?
C) What ADL’s is the member not able to accomplish without the use of a power wheelchair?
ADL = Activities of Daily Living (food, bathing, bathroom, etc)
So tomorrow I’m off to see Laurel to make sure they have all this stuff. Over the past few weeks my right leg has gotten so wonky lifting it isn’t always possible. Weird muscle fatigue issue or something.
Saw Laurel. She is truly wonderful. Gush gush gush. For some reason she never got the letter from the insurance.
It was all for the best though, my right side has gotten significantly weaker since last we did any tests. Push, pull, resist, ack!
She showed me an awesome yoga stretch for my shoulder. HOLY COW! It’s so so so much more than any of the other stretches I’ve been doing.
Regence sent CareMedical the denial of claim letter. I never got a copy. CareMedical may or may not have gotten their copy. Clark didn’t seem to know anything about it.
Laurell faxed me what she sent Regence. According to those documents I qualify for the powerchair. Aside from her PT eval there was also a recommendation from my physiatrist.
Called Regence and appealed. Couldn’t get any information from them as to what papers they actually got. They did send me (eventually) the rejection letter originally sent to CareMedical. The appeal letter wasn’t written yet so I didn’t get that.
Called Regence to ask where the hell my appeal letter is. The appeals panel is still reviewing my paperwork and they haven’t achieved a thought yet much less a decision. So the clerk on the phone is sending me info on what happens with the appeals process and all that good stuff.
Regence again has got less than their required allotment of clues. Apparently the appeal was sent to Level 2 Appeal, not the expected Level 1. So its been shuffled back and forth between those two departments each saying, “Not enough medical data to support claim.” Uh huh. On hold with them now while the helpful Clueless At Regence Customer disService Member tries to figure out wtf is going on with my claim.
So I’m told that chances are good that I’m getting denied the powerchair because there’s no medical documentation that says I couldn’t use a manual chair. From the inferences the rep gave me the insurance wouldn’t have a problem with a manual chair. What ever. So now its back to getting more charts and notes and and and dictating why I couldn’t handle rolling myself around.
Oh, and the first level appeal was denied.