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Trfogey- you are correct. I misunderstood. I believe he still has medicare and his POA switched his private insurance. Would we try to get both insurances to cover the full cost or can we only go with one of them? I dont understand how insurance works. I got your PM and just wanted to tell you how much I appreciate all you are doing to help.

I'm not much of an expert on multi-insurer claims myself, but the vendor or dealer that will actually sell you the equipment will certainly know the best way to file claims so that you get the most out of your insurance coverage. You can also apply for grants from your local ALSA and MDA chapters to cover some of the costs that the insurers don't cover.

If you are not already a member of the Patients Like Me website, now might be the time to join just to ask these questions over there. More eyegaze users over there, and also more folks that are familiar with the insider knowledge to get things done in the American health care system.

Kelly- you are right. this is amazing how much you all have jumped up to help out my PALS. there are no words to express what this means to me. and to Ray. Once we get this taken care of, I will let HIM be the one to come up with the right words to appropriately thank all of you. You are giving us hope and a chance at a new life together.

Everyone- Im speechless. I would love to kiss every one of you right now. you all deserve an award. much love. and many thanks.
liz

Liz, he may be your PALS, but he is our brother. We may bicker and feud around here, but when the rubber meets the road, you both are family. Just wish we'd all heard about this sooner. Six years without a voice is way too long.
 
I know its way too long. Like I said in the beginning of the thread, I really thought that he knew about this stuff and just chose not to use it. He did have one of those sensors that goes on your forehead when he could still move his head. I guess i just thought he knew and that is why i never asked.
That is exactly why i will never assume anything when it comes to him again.
its truely heartbreaking.
 
Also, trfogey- thank you for the kind words. it means alot coming from you.
 
Liz, I would like to add that if the insurance/Medicare doesn't cover the total cost and he cannot afford the copay, ask the vendor for a "financial need" form. Different vendors have different names for the forms. Usually they are very accommodating in that regard, as they would rather have the money from insurance/Medicare than none at all.

Please keep us informed! Hope he finds something that works for him.
 
CJ- thanks for the tip. so when you say vendors, you mean the folks that sell the equipment right? so other than the dynavox website, where can i look for this stuff?
 
If you are going to use insurance/Medicare to pay for the device, then you will have to get an evaluation from a speech language pathologist, who will in turn "prescribe" the best option for him. Then an area vendor rep will become involved upon delivery of the device for training and set-up purposes. Otherwise, you will need to seek out the loaner options or donations, such as from the ALS Guardian Angels or ALSA.

Sometimes pALS/cALS will donate to another in need, as they may have one sitting in a closet that they were unable to use. But you may still need some help with instruction, which is where the ALSA should be able to help out.
 
Liz,
i'll get you guys one. Please call me.
Stu 949-233-3045
 
OH MY GOSH! STU! Thank you thank you thank you! Ive got to take Ray for a dr appointment today, but I can call this afternoon if that works for you?!
 
There's our angel coming through God Bless you Stu.
Sharon
 
Medicare covers SGD (speech generating devices) and eyemax.

He needs an appt to see a speech therapist to be evaluated if he can use one. I played with one in our technology department and if you stare and hold, it will select for you like a mouse click.



The speech therapist will be required to justify the device.
  • Obtain an order from his physician for speech therapy.
  • The speech therapist will eval and write the justification letter for the device.
  • The speech therapist will work with a supplier that sells the device.
  • The supplier will help process your Medicare as well as supplement or secondary insurance information.
  • ALS/MDA as well Guardian Angels should be payors of last resort to help with costs not covered by insurance. One of these agencies could provide a loaner while his device is pending.
Good Luck.
 
Do try to get a loaner though, it took us six months to get Liz's. Between the evaluations and the insurance and delivery, by the time we got it she was too weak to use it.
 
Dana- Thank you very much for the detailed info on how to do this! And pepsiman- thank you as well. Im sorry things turned out the way they did with your wife.

Here is the update. First, I want to clear up something that i was wrong about. I previously stated that it has been 6 years since he's been able to "say" anything to anyone other than mom and me. Once again, I was wrong. Just before I started taking care of him, he did have a system that talked for him- and it used something that was put on his head when he still had head movement. So 6 years is wrong. It has, however been 3 years, which is still way too friggin long.
Anyways, I talked to our Angel, Stu. And of course he is going to help however he can. He put me in touch with a lady whose son has ALS and also lives here in WI. She will be letting me know ALL of the services available to my PALS, not just about the eyegaze, but EVERYTHING.
I have been advised by both Stu and you guys, how to go about all of this so the next step is to have his POA call the insurance companies to see if they will cover the costs. And, if we cannot get it covered by them and/or other agencies, Stu is going to step up and help us out.
GOD BLESS YOU, STU.
And to all of you on this forum- you have all earned a very special spot in my heart and if there is ever anything, anything at all, that you need from me- please dont hesitate to ask. I believe in passing it forward.
So, looks like my PALS will have a voice again, afterall.
 
My two cents.
Generally, your primary insurance will have to have some sort of prescription. Once that is done, then as long has you haven't used up your DME (Durable Medical Equipment) benefit, they should cover. If you have used up the benefit, then the provider will receive a denial from the primary, then send to Medicare. Medicare generally covers 80% of the cost if you are purchasing an item.
 
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