"Medically Necessary"

I have been brewing over our recent situation with Claudia's wheelchair.  Claudia turned 14 this month so she has been using her current wheelchair since the age of 9, sitting in it for close to 15 hours a day.  That is close to 27,375 hours of sitting in that chair.  She has become a woman in that time.  Her body has undergo tremendous changes.  One of which was a back straightening spinal fusion that happened last summer.

It is no wonder that her wheelchair is quite literally falling apart.   She has outgrown it.

A new wheelchair was agreed to be necessary by all her doctors and therapists last summer as it was obvious her new shape would no longer fit into her old wheelchair.  So LAST summer we began what we hoped would be a quick process to acquire a new wheelchair for Claudia.

It is probably no surprise to you have we are still without a new wheelchair... TEN months after we started the process.  The process involves a multiple wheelchair assessments, trial appointments with a sample wheelchair and a therapist writing an extensive letter of medical necessity.   That was all done by August, but it still had to go through a medical vendor that handles the claim, processes the insurance and orders the equipment.  They did not process the claim until October.

Then came a denial, and then another denial and then another..

Until we are now faced with going to a Fair Court Hearing in May.  Can I just say that no one wants to have to NEED a wheelchair!  No one wants to have to fight the system for a year to get a wheelchair.  This is completely ridiculous.

I refuse to give up.

Claudia needs to have her medical needs supported in the best way that they can. It makes me very sad to see that she is starting to lean over.  I'm extremely worried about what is happening with the hardware inside her body.  This year without the proper support it has been difficult for her to sit up and heal.

The denials deem that the wheelchair is not medically necessary....

"Medically necessary" means a covered service is provided by a physician or other licensed practitioner of the healing arts within the scope of practice under state law to prevent disease, disability, or other adverse health conditions or their progression, or to prolong life.