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ShiftKicker

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Joined
Mar 16, 2015
Messages
8,348
Reason
DX UMND/PLS
Diagnosis
06/2015
Country
CA
State
BC
City
Vancouver
This isn't directly to do with MND, but I'm sure others have run into this type of thing before when dealing with insurance companies.


A while back, I was told I needed a lift recliner to help me in all sorts of ways- mostly for help with edema and comfort while sitting. I looked at our extended medical insurance, which stated doctor prescribed medical equipment was covered. I ordered a chair and submitted the prescription for approval to our insurer. Who, of course, promptly issued a refusal because they stated lift chairs are not covered- no reason given. I sent in an appeal, citing policy and identifying which paragraphs in the policy indicated lift chairs, as prescribed medical equipment, should be, indeed, covered. I again indicated medical need and received another refusal stating a lift chair is only a "convenience" and it would not be covered. I would have given up, but for the "convenience" reference. That just made me mad. I don't have the best executive function these day, nor the energy needed to do paperwork that would have been a snap in the past, but apparently ANGER is the magic anti-fatigue drug I've been looking for. I wrote a couple of firmly worded emails that may or may not have indicated certain people didn't know what the term INSURANCE meant, and stated how much in union dues had gone towards our medical plan, and asked what the union reps were going to do about it. Today I received an email from the union stating my appeal had been approved.

Now, I used to coordinate insurance as part of my duties as a sports league (roller derby) administrator and member. I was responsible for negotiating the original liability and health insurance policy for my league- and I was the first to do so for any league in Canada. People didn't know what to do with us- they deemed us a big giant risk, as we were a new incarnation of a sport that had a shady history- and a full contact one at that- and no one had run into insurance for such. In the past Roller Derby was considered "entertainment" and not the full contact rugby on wheels it eventually became. The policy I helped write with the original insurer is the one that all subsequent Canadian leagues used as a foundation for a nationwide organizational policy, as well was incorporated, in parts, into the subsequent formation of the Women's Flat Track Derby Association in the States. I could write proposals and appeals with the best of them and made sure all our injured and travelling players had the coverage they needed when injured during games all over the N American continent, as well assure business owners we were legit and had liability coverage. I coordinated with police departments and municipal governments on a regular basis for our events and organization and dealt in liability policies in the millions of dollars. However, I don't think I've ever been as proud as I was when I got approval today for a single gosh darned chair. Man, how times have changed.

Maybe this should be in the stories of hope section, but I was feeling ranty originally.
 
Good on you, Shift. I wish all our people were so courageous and persistent.

Anger is a great motivator. Personally, I get my best work done when I'm in a flaming rage.

Hopefully a bunch of people at the insurance company have learned a lesson.
 
Mike, a flaming rage along with a couple glasses of wine. I do my best and most creative writing with a glass or two, I will admit. But I do adhere to the "save to draft" policy and only hit send the next day after I do an edit or two. I learned my lesson a few years ago- eminently satisfying at the time, but many hours of diplomacy to recreate a working relationship again.

I think insurance companies depend on people being too ill or distracted by poor health and immediate need to keep fighting. Attrition is their game. It's unconscionable.
 
Shift kicker,

It's a shame that we have to get mad and fight so many battles, with the limited energy pALS or cALS have.
I fear for those who can't advocate or don't have someone to do it for them.

As Mike said, good on you!

Sherry
 
Well done!

It is sad you had to get so mad to get it achieved, but it may also really help so many PALS in the future with the same application. Happy dance here :)
 
Congrats - you've definitely got an extra "F" in your user name :)
 
:grin:
Way to fight! You should feel proud!
I think insurance companies automatically decline many things, hoping people will just accept it and move on.
I hope your chair brings you much comfort.
 
Fiona you make sure that chair comes with all the bells and whistles the insurance will cover...I'm pretty sure they won't knock you back for anything!
 
I thought Medicare- and other insurances usually copy Medicare- would pay 80% of the difference between a standard recliner and a lift recliner. The idea being to pay for the lift mechanism but not the chair itself. I can understand that I guess.
 
Hi Diane- I'm in Canada, where things are slightly different. Recliner chairs of any sort are not considered medical equipment here, regardless of prescription. That was made pretty clear when the rejection wording was described as "used for Patient Convenience". This chair will apparently be funded by a special union administered fund and not, in fact, by the insurance provider the union uses for its members. Politics and all that. Regardless, I am thankful for having the vast majority of it subsidised- I have a feeling I'll be spending a fair amount of time in it. It does make me worried for when I may need other equipment in the future, however, this battle was (sort of) won.
 
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