Friday, February 11, 2011

Understanding "The Process" (Part 2)

I was thinking about the information I gave you in "Understanding the Process--Part 1", and I owe you all a big apology. I was a Bad Bunny

What I should have told you was that when you're waiting for your appointment to see your doctor to talk about possibly getting some equipment, you should be contacting your insurance company to see what their policy is regarding getting assistive technology or durable medical equipment.

Let's take a quick time-out to talk about durable medical equipment (DME) and assistive technology (AT). DME is a subset of AT, meaning NOT ALL assistive technology is durable medical equipment, but all durable medical equipment IS assistive technology. When we look at what DME is, we see that it's essentially medical assistive technology (ventilators, wheelchairs, walkers, hospital beds, standers, etc.). That's different from say non-medical assistive technology (Don Johnson SOLO or Kurzweil 3000). Now, there are a lot of things that aren't considered DME that many people think should be considered DME, but we're not here to talk about that. We're here to talk about how to get the stuff we need. Time-out over.

Checking things out. . . 

Once you contact your insurance company, you should ask if your policy, especially if you have private insurance, covers DME. If it doesn't, kindly ask the person you're speaking with to point out where that exclusion is made in your policy. That's important because that's the proof that indeed your coverage isn't there for your equipment. If you can't be pointed to anywhere in writing where equipment is not covered or excluded, you may want to ask for a supervisor and see if that person will help you understand the equipment policy. They should be able to tell you the extent of any AT they will cover. If your insurance will purchase DME and other AT for you, you can find out if there is a specific process for getting the equipment. Often there is, but most people don't know that process. Case in point, many people believe Delaware Medicaid will not pay for communication devices. That is simply not true. DE Medicaid will pay for a communication device if you have a letter of medical necessity completed by a licensed Speech Language Pathologist (SLP) AND the SLP has tried at least 3 different devices with the individual. That last part is where most people have a problem-- they don't know they need to try 3 different devices. If you know the rules before you try to get your equipment, you can save yourself a lot of pain, blues, and agony.

So now you've seen your doctor and your doctor agrees that you could use some sort of AT. What happens now? Well, before you decide to just go purchase whatever it is s/he's recommending, you may want to get a referral for a licensed therapist who specializes in the type of equipment you need. If you need a wheelchair or mobility device, you may want to see a physical therapist or occupational therapist that specializes in mobility. If you need some respiratory AT, you should see a licensed respiratory therapist. If you need a communication device, you should be seeing a licensed SLP. The most important thing is that you have the proper licensed clinician involved. How do you know if you do or not? Ask your doctor for  a referral first and foremost. If the doctor is used to working with a specific therapy group, that is the best place to start. If you have experience with a therapy group and they have experience in the area in which you need help, by all means, go back to them.

Now this is perhaps one of the most important parts of this phase of the process. Before you have your appointment to see the therapist, make a list of all of the questions and concerns you have about the equipment. "Will it fit in my house?" "Will I have to pay for any of it?" "Can I choose the color?" "How big is it?" "Can it fit in my car?" Just make note of any questions you may have even if you think they are silly. You may be surprised that not only are they not silly, but they're rather important. One question you may want to ask that they might not have a really good answer for is how long it will take to get the equipment.

Before the equipment can be purchased, it has to be approved for purchase by the insurance company, Medicare, or Medicaid. Once that happens, the vendor can purchase the equipment and you will be one step closer to getting your AT. Still, before we worry about what you're getting, we need to look at the evaluation.

Photo courtesy of Red Hat magazine

So after the therapist has conducted their interview, tests, taken any necessary measurements and impressions for any custom fitting, and performed any equipment trials, it's time to pick the device! Now, the type of device might not be fully yours to choose alone. If there's a specific family of device that you would need, the therapist will usually recommend that. Some insurances require that the clinician specify the exact equipment you will need. While that does limit your options, they are doing so for a reason that benefits you. Just make sure you ask why and they can explain their thinking. It's kind of like talking with a car expert about what type of vehicle to get. The expert might recommend a diesel truck if you're gonna be doing a lot of hauling of heavy stuff. Now, you could go get the Mini Cooper, but when you need to make your first haul, you'll probably be regretting your decision.

Now, this is very important. Before the equipment request goes in and before you work on choosing your specific piece of AT, you may want to take a day or two to look over options and make a decision on just what specific device you want. This is especially important in wheelchair selection. If you have a vehicle and you're getting a manual wheelchair, you may want to go to the vendor's shop and "try" some wheelchairs to see if they're easy to get in and out of, easy to get in and out of your car, or even if they will fit in your car. You may want the vendor to bring some models out to your house to see how they fit through your doors, how they're gonna get into your house, or even how you're going to transport them. Choosing the color is important, but these other considerations are a little more important.

So now we know the general type of device we are going to get. The next step is to "get to know" the device with the therapist and the vendor, and that will be in part three of the series!

See you then!

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