Impediments to mobility are caused by different factors ranging from age to illness to genetic conditions. When one is unable to perform necessary tasks like walking, they require an aid. Mobility products promote independent living and participation in community life. They reduce the reliance on human assistance.
These products are not cheap. Hence, the need to have insurance cover. Disputes in coverage of mobility aids are common and problematic. There is language used in the rules of engagement that causes ambiguity in coverage.
Even with coverage, there are inconvenient limitations. Some insurance plans do not cover aids for a pre-existing condition. Others will only cover only a specific percentage. Some plans limit the frequency with which one can get a product while others have an approved list of healthcare providers and vendors. These restrictions reduce fraudulent activities and enhance quality of care.
Conditions for Coverage
There are requirements that one must meet to ensure their claim is approved.
This is the necessity for treatment of illness, injury, or to improve the functioning of a malformed body member. An approved medical professional determines this. One is subjected to all manner of tests to ensure this part is proven. If a doctor does not prescribe the product, high chances are that the claim will be denied.
Evidence has to be presented to the company showing, beyond reasonable doubt, that the mobility product is necessary to daily functioning rather than recreation. The product must also be able to withstand repeated use. Otherwise, one might have to cover replacement out of pocket.
Risk of Not Having Aid
Can you walk without assistance? Can you get yourself to and from the bathroom? Can you dress yourself? Can you move with ease to open the door? Can all these be done without danger of falling over?
These are important questions to ask before one begins the process. The healthcare provider has to demonstrate the danger posed to your welfare if you do not have a mobility product. They have to show that how using a mobility product will be safer for you. The product must be used primarily and customarily for medical use.
Can you get safely on and off the wheelchair or scooter? Is there risk of falling while on it? Are you medically sound to operate it? If not, do you have someone to help in using the device safely?
These questions determine whether daily living will is made easier or if the device will only bring about more expenses from falls and muscle injuries. These questions will also mean the difference between a manual or motorized wheelchair.
This is one of the limitations mentioned above. The doctor performing all the tests must be approved by the insurance plan. If not, you might be subjected to the same tests by a different doctor. The insurance companies, due to either suspicion or past fraudulent activity, do not trust some healthcare providers. Others just have questionable quality of healthcare service. Whatever the reason, one must ensure their doctor is board certified and approved. The mobility product supplier also has to be approved. This is purely a matter of quality.
Usage Within Home
This does not mean one cannot use the product outside the home. It just means that if you cannot be mobile within the home, how hard is it outside. However, evidence might show that the product is only useful outside. In this case, the claim might be denied.
Whether a wheelchair or scooter or whatever other mobility product, it must be able to fit within doorways and hallways. If the wheelchair is too tight for these spaces then it defeats the purpose. Coverage is determined by rigorous assessment of all mobility aids to choose one that most appropriately addresses your needs.
This point causes many coverage disputes but one should be able to navigate if the other points are not contentious.
The terms of different insurance plans vary. You may not have a need for mobility aids at the commencement of coverage but need one at some point in the course of the contract. At this point, you realize your cover does not include mobility products at all. There are two things to do if you cannot pay out of pocket for the aid. One is get secondary insurance. This is the engagement of another plan that has the additional requirements. The other is canceling the plan and taking up another insurance company. Before cancellation, you must weigh both options to see which one will be less expensive. The cancellation procedures of some companies are excessively complicated and costly.
To find a cover that will suit you better, the following will guide.
Upon contact with an insurance company or agent, you will receive Evidence of Coverage. This document contains details about the coverage. What will be covered and how much it will cost.
If one is not strong enough to use walkers or canes but have upper body strength or a caregiver, a manual wheelchair will be recommended. The other option is a scooter. It is cheaper than an electric wheelchair but then you have to be strong enough to sit up and operate the controls. In the absence of these two, one can then opt for the motorized wheelchair. This is for people who cannot sit up like paraplegics for example. The joystick can usually be swapped for a friendlier form of control.
The information regarding degree of coverage for the above is contained in the EOC.
How much will cancellation of current insurance plan cost? How much will taking up a secondary insurance cover cost? If you forgo the two, how much will the premiums run you? What is the co-pay percentage?
These pertinent questions enable you to compare the costs with benefits. Some covers that offer lower costs end up costing you more in the long run. It is imperative a meticulous analysis of the fine print is done. One can get either an annual cover or a three-year contract. The longer, the cheaper.
Some plans cover mobility product related accidents. This may include court charges or costs to get the scooter home after the fact. Others may cover repair and upgrade.
You can tell the kind of service of a particular insurance company from online reviews. Most people post their patient experiences for prospective clients of the company to use during the decision making stage. The amount of time the company takes to approve claims. The rate at which the company approves or denies claims. These can all be found in online reviews. The company has to have ease or registration and processing.
While at it, you can also research the reputation of approved vendors and healthcare providers. This assures you of great service when you go in for review prior to approval of claim.
While some covers insist on reasonable lifetime period, some may be a little lax on that. If your specifics have changed, the plan might cover a replacement upon proof. You need to confirm the conditions for this.
You should find out if the plan covers accessories and home modifications like ramps and batteries.
There are instances when you will feel overlooked or taken advantage of. You pay your premiums on time and should therefore get timely service.
When the approved vendor or healthcare provider is being less than cordial, it is okay to complain. They may make you wait or claim that the mobility product is irrelevant. You should complain and complain loudly to the insurance company. You should file for independent review with the relevant authorities to get audience. This is not a favorable situation for the company; they will ensure the situation is resolved within no time.
There are also cases where the company denies claim for a reason other than medical necessity. In this case, you need to ensure you know the reason why the company denied the claim. If you disagree and rightly so, you should speak up to whoever will listen. You should, however, notify the company first of your disapproval of their decision.
If the cover is meant to cover repairs, it should do so without fail or excuse. In some cases, the vendor is tasked with the responsibility to repair mobility products. Some drag their feet. You should complain to the company about this. The duration of repair, the vendor should make a placeholder for the device. You should be mobile whether your scooter or wheelchair is at the shop. Whatever the case, the company should ensure your mobility aid is repaired when required even if they have to go out of their way to find someone to do it.
Keep Careful Records
The engagement of an insurance plan is a contract. As with all contracts, one must keep all the paper work. Even the most mundane looking piece of paper or receipt could prove important. This will help when you need to make a claim or use the warranty. It will also come in handy when there is a delay or denial of claim. There are times when representative will make promises, ensure they put it in writing.
Insurance will cover your mobility products. However, there are times when claims will not be approved without a fight. You need to meet all the above conditions to ensure there is no room for denial.