Get out in the community!

Being part of the community is worth the struggle

By Louis Patrick

My wheelchair is five years old, so, theoretically, Medicare would approve my getting a new one. I talked to the company I’ve been dealing with for several years, and we agreed on the specifications for a new chair. I should have known things are never so easy. I got a call last week from someone in the company telling me that Blue Cross had turned me down. They needed more information—preferably medical, of course. He said the company would re-file.

It’s been my experience that it’s not wise to leave such matters unattended. I called BC/BS’s “customer service” line and asked to speak to someone in the group who had denied my claim.  The sweet young rep explained that she couldn’t do that; they had different phones. She looked up my records and told me that, yes, my claim had been denied, they didn’t have enough information to establish that I needed an ultra-light chair, but that I had the right to “appeal.” They had not received an appeal from the company yet. She called them and found out they had not have received the denial by mail yet; she would fax it to them. If I liked, she could fax or mail the appeal application to me, but, no, they aren’t allowed to use email.

Now, first thing, I’m 68 years old, as is my wife. Silly me, that alone seems like reason enough; nobody my age should have to lift a tank of a wheelchair. I didn’t think to tell the rep that, however. I did tell her that I’m very active; I’m out and about very often through the week. I drive and need to be able to get my chair in and out of the car easily. Also, my wife needs to be able to get the chair in and out of the trunk when she and I are riding together. And I reminded her that being active in the community, dealing with other people, is a well proven tonic for health. Staying bottled up at home alone is a killer.

Insurance companies are great believers in Nancy Reagan’s philosophy: “Just say no.” Whenever possible, deny claims. Adjudicate. Wrap up the claim in red tape. Many, if not most, people will simply accept the denial.

I was at the Center talking about this with a good friend. She had just been denied payment on a feature that reclines the chair, taking pressure off the tush. She was told she was eligible for a “Group 2” chair but not a “Group 3” chair. Again, to be active in the community for several hours the reclining feature is very helpful—and healthful.

I’ve also heard before that Medicare was clamping down on heavy duty wheelchairs unless needed IN the home. This is a straight-forward matter of health: Get out of the house! Get out in the community! It’s better for you.

Never take no for an answer. Fight for the equipment you need to stay active.

Louis Patrick is on the Board of MCIL.