Rehabilitation Equipment Evaluations – The Key to Getting Your Insurance To Pay

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If you are a person with a disability that uses a wheelchair, scooter, standing table or almost any type of rehabilitation equipment, you know that most insurance companies will provide payment only after the approval or evaluation of an (expert). This process is important and necessary but, can also be very difficult. It usually occurs at a clinic once or twice a week, where most often you, the person in need of the equipment are a number. Especially, if you are using a state agency to help you cover some of the costs along with your insurance company.

The person doing the evaluation generally is a physical therapist or an occupational therapist with lots of knowledge in a specific area, But frankly no knowledge, in what it’s like to live with a disability independently. I have nothing against this process or the people involved. I have said that they are absolutely necessary, however, it is imperative that you as the person with the disability find your voice. The same goes for the person who may represent a younger child in such a meeting. The (experts) are not really experts at all. To be honest, they have less knowledge about what you need and how you live, then you do. It is important to be extremely tactful, while expressing your needs or the needs of the person you represent. Even with all the experience I have living independently and representing my own needs in these types of situations, mistakes are made that I have paid for. The fact of the matter is, when you buy a chair or other equipment, the end product is something you have to live with for at least seven years.

This is what I suggest, let the experts do the measurements and the fitting, because this is an important part of the process. If the chair fits well, it is easier to live with. The largest mistake that happens in these evaluations, is when the person with the disability doesn’t ask for a particular function on a wheelchair because they’re told. it will not be approved by the expert. No one knows what the insurance company will approve. If they do not approve something, there is always an appeal process. As the person using the chair, you can always make the decision to purchase the function that’s not covered by the insurance company. It may come down to affordability, but you have the choice to purchase the function or not There will be a delay in the process if you decide later to amend the order because of an oversight in the original paper work. I said in past articles that you must pick your battles. Accessories such as foot pedals and/or foot plates on wheelchairs can be changed fairly easily at minimal cost. In most cases, you must look at the big picture. The frame, the functions and the over all structure of the equipment is the most important.

It is imperative that the equipment purchased fits the lifestyle of the individual who’s going to use it. Sometimes there is a tendency to buy equipment that never gets used and will end up in storage. Modern wheelchairs are great. If you have to transport someone in a car that does not have a lift or room for the chair, it may not be the right equipment, and can lead to even more limitations. There is no right or wrong way to approach this process. As much as you may dislike them, they are what makes the system work. All be it imperfect, it is the one we have. Be tactful, vocal, and pick your battles. In the end you will get what you need.


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