Where does one even start reflecting back on the year of 2020? This has been a year to remember for the ages from pandemics to politics to pandemonium around every corner of the globe. The human race has endured throughout the ages and what millions of us are facing today will undoubtedly be written as a dark chapter in the history books, but there’s one overarching concept that continues to guide many of us during these dark times – Hope. Hope for a better future, hope for a vaccine from this pandemic, hope for our fellow humans to be kind to one another, and hope for the will to survive both physically, and mentally.
Each one of us has been faced with our own personal hardships & challenges, and while many of us may have trouble seeing beyond the trees within the vast forest – we will somehow prevail as we have done for thousands of years.
For me, 2020 has been a year of incredible clarity. While there are moments I feel intense guilt for thriving in such a dark time, I have finally found my purpose in life. In short, fighting for those who cannot fight for themselves. After 10 years of fighting my own personal battles for survival through the labyrinth of all of the complications that accompany a spinal cord injury and being paralyzed from the chest down, I finally reached a tipping point in my own life where I’ve come to realize how short life really is.
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 ….
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.
Each morning I wake up at the crack of dawn, work with my caregiver for several hours to get ready for my day, and then pump out work for around 10 to 12 hours each day, continue to work my caregiver for afternoon activities, then rest, repeat, and start again in the morning.
At the ripe young age of 10 years old I attended Catholic boarding school in London, England. I’ve been conditioned to work harder, smarter, more efficiently, and just keep going. Don’t get me wrong, I have my fair share of fun, but hard work has been ingrained in me as long as I can remember.
My definition of work has changed over the years and now encompasses spending my day working professionally, advocating for those who can’t advocate for themselves, working on trying to build a large social media following in order to affect greater change, and find some kind of balance in my personal life. I’m not always brilliant at it and I know there are so many other people in life trying to juggle balance too. Continue reading →
After a long and arduous 7-month road of winding adventure of denials, appeals, and out of the box advocacy techniques … I’m proud to announce I took receipt of my new power wheelchair yesterday with the seat elevator I was denied.
I outlined several detailed articles in Push Living Magazine (article 1, article 2, article 3) on the labyrinth I had to make my way through during this process.
I went to the local media and was able to land a written piece by News & Observer and a small TV segment by ABC 11’s Diane Wilson, investigative reporter, on the battle I underwent.
During this pandemic the most unlikely of things happened. I developed a laser focus and passionate advocacy mission all the topic of health insurance denials for medically necessary equipment.
Whether you have Medicare, Medicaid or private insurance, there is a process, albeit tedious more often than not, where you can navigate your way through the maze of red tape to overturn an insurance denial. You have Rights!
As I was lying in bed last night the metaphorical wheels were turning in my head with respect to the next move I am planning on making towards my advocacy mission with getting durable medical equipment and services paid for by Goliath health insurance companies. My mind unexpectedly wandered off into the most unlikely of places. I needed to wind down my brain to try and overcome my insomnia when I started giggling out loud.
Somehow I started reflecting on some of the most embarrassing moments I’ve endured over the last 10 years living this life in a wheelchair. When living with a spinal cord injury there are a 1,001 things that can go wrong in your life on a daily basis, most of which are frustrating, dangerous, embarrassing, and suck the life out of you, but I find there can be humor in most situations.
Whenever I read other people’s blogs, websites, stories, etc. I find the ones most interesting who share their personal experiences in a raw form because so many of us can relate to those moments. If you do not have a disability, I’m sure what I’m about to share with you will hopefully make you laugh, perhaps shy away from reading a certain sentence or paragraph, but at the very least will make you appreciate some of what many of us with varying disabilities deal with on a daily basis. If you do have a disability I’m sure you can relate to at least one of my stories!
Without further ado, I’ve invited myself to a “Roasting” as they say in the celebrity business. Continue reading →
Over the last several months I’ve engaged in a head-to-head battle with my insurance company, Blue Cross and Blue Shield of North Carolina (BCBS), for a critical function on my power wheelchair called the seat elevator. The seat elevator was deemed not medically necessary by my insurance company and after multiple appeals I was sent a final denial letter by BCBS.
Last week I wrote an article outlining the various steps I have taken over the previous several months in fighting with BCBS over approving my seat elevator for a power wheelchair in regards to the process I have been through, why the seat elevator is medically necessary in my situation, tips and tricks for others, and my overall strategy (https://pushliving.com/the-fight-for-survival-health-insurance-battle-tactics-for-medically-necessary-services-part-2/.) I was in the process of pursuing an external review with the North Carolina Department of Insurance to overturn BCBS’s final denial of my seat elevator. Every state has its own Department of Insurance who sends your external review to an independent review board.
I’ve been through the appeals process many times over the last ten years of being injured, but this time was different. I went a step above and beyond to reach out to local news stations, wrote letters to the CEO BCBS NC, and had several folks working on the internal side. I’m not sure which avenue yielded this welcome and frustrating result, but here’s what happened:
We should be enraged, inspired to change, and determined to fight as Americans with the state of our healthcare system in this country. The fact that we spend 2 to 3 times more on health insurance in the United States for subpar services as compared to many other countries in the world is outrageous. It speaks to the issue of no regulatory authority in our healthcare system. The government does not regulate healthcare prices resulting in huge price variations in addition to, but certainly not limited to, consistent denials for countless medically necessary services and products for many hard-working Americans.
-I have a Story –
Tens of thousands of others share similar stories. I’ve had enough and it’s time to fight for my survival and for those who cannot do it for themselves. I’m hard-working, pay into our governmental system, and spend $8,000-$13,000 per year out-of-pocket for health insurance only to be denied medically necessary equipment at every turn. I have spent hundreds of hours over the last several years fighting quietly for medical services I need and now it’s time to take the fight public. This is an issue of basic human dignity so that I may live my life with independence and freedom despite being severely physically disabled.