Wednesday, March 9, 2011

Understanding "The Process" (Part 3)

Ok, so now you've talked to the doctor who agrees you can use some assistive technology (Understanding the Process Part 1) AND you've seen a licensed therapist for an evaluation for your technology (Understanding the Process Part 2). What happens next? Well, now it's time to pick your tech! Now, you're not gonna be left to your own devices. Your device selection will most likely be guided by the therapist who evaluated you and a durable medical equipment (DME) provider or salesperson. The salesperson may need to take your body measurements for AT like wheelchairs, walkers, canes, standers, and the like. You may also get the chance to pick the color of your AT, if it comes in different colors. You should ask all sorts of questions now-- What does it look like? How do I take care of it? Can I fit it in my house? How am I getting this up the stairs? How am I going to fit through the front door? How am I going to transport it? These are all questions that a good DME provider will help you answer. If you can, try to make a list of questions you may still have about the equipment. Now's the time to get them answered before everything starts showing up. Also, if part of the equipment request needs to be changed, this is the best time to do that.

Once the equipment has been chosen and everyone's happy with the recommendations, the therapist may write a Letter of Medical Necessity, or LMN. This is a very important part of the equipment request that's submitted to the funding source. It explains why you need the equipment, what benefit you'll get from it, what problems you have not using it, and how long you're expecting to use it. You should request a copy of the LMN for your records.

Once the LMN is sent to the funding source, along with the equipment quote from the DME provider, the waiting game begins. The funding source can approve the request, request additional information (not approved or denied but limbo), or deny the request. Now here's the tough part-- the response (approval, request for more info, or denial) should come in writing. It should. Doesn't mean it will. If you don't get a letter, you should contact your funding source for one (we'll talk about the importance of a case manager in another post). That's where, if you received a denial or a request for more info, you'll be given more particulars about why there is a hold-up in the request. Once you know this, you can get your team to help you fix it, if you can. If the equipment is denied because it's not a covered benefit or if what you're asking for is beyond your eligible benefits, you may need alternative funding (we'll talk about that later too).

One thing that's very important to keep in mind is that if you get a denial, you should always, always, always appeal it. If the LMN is sound with good justification for the requested equipment, you may not need to do much to win your appeal. However, in some instances, you or your therapist my need to provide additional information to support your claim.

Hopefully, you'll get an approval and there will be laughter and merriment throughout all the land! The DME provider will then deliver and fit the equipment and you will finally have your assistive technology!

Is that the end? Nope! When you schedule your delivery appointment, you should also schedule a follow-up appointment with the therapist you've been working with to get the equipment. During this follow-up appointment, the therapist can make sure all of the equipment fits properly and/or is functioning properly. This is important because if there is a problem with the prescribed equipment, the therapist can make note and see if any necessary changes can be made. This is a step most people forget and it's very important. You should try to schedule a follow-up appointment within 3 weeks of getting your equipment. Also, make sure you give your doctor's office a call to let them know you have your equipment. She may want to see you later with your equipment to see how you're doing.

There are still a lot of little things I didn't go over in "The Process," but this gives you the 3 basic steps to it. In part 4, we'll talk more about dealing with funding sources and the joy thereof!

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