Am I Manipulating the Health Insurance System?

 

Over the last several years I’ve made it my mission to try and overturn health insurance denials for what I, and many of my medical professionals, deem is “medically necessary” for in-home use with my specific quadriplegia medical condition.

Often times my insurance company believes that the type of medical equipment I try and have approved, usually referred to as Durable Medical Equipment (DME) is not “medically necessary” for me, but rather an “accessory” to my life.  My job is always to try and prove that their definition of medical necessity is skewed for the very small segment of the population who suffers from paralysis.

…. Recently, there were a few wheelchair users who made comments to me that I was simply manipulating the system and making it worse for everyone because I am trying to “game” the system.  They were trying to say that I don’t NEED the equipment I am after, but rather WANT it …

… This really got me thinking!  Am I manipulating the system?  Let’s dissect the argument ….

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Health Insurance Approval for Specialized Shower Chair – Unexpected Win!

 

Since winning the approval of my seat elevator for my power wheelchair through navigating the labyrinth of Blue Cross and Blue Shield’s appeal’s process by taking my story to the local news – I have since been busy making quick work of trying to get further “medically necessary” equipment approved by insurance.

A challenge many of us face within the world of health insurance and disabilities is trying to prove, and convince insurance companies that many pieces of equipment we need in our home such as specialized shower chairs, seat elevators for power wheelchairs, specialized manual wheelchairs, adaptive exercise equipment, etc. are not “accessories” as defined by health insurance companies; rather they are “medically necessary” to not only survive in our daily lives, but to thrive.

In this light, my advocacy mission to help folks learn how to be their own advocates has really taken off.  I thought of no better way to teach folks how to be their own best advocate than by working towards getting equipment in my own home that is “medically necessary” approved for myself first.  This way I can better help folks navigate within the private health insurance world first, then later on to Medicare & Medicaid, with respect to best practices & strategies for winning health insurance denials.

About a month ago I embarked on my next mission to see if health insurance, specifically Blue Cross and Blue Shield, would pay for a highly specialized shower chair.

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