Truth and Reality as I know it to be

Posts tagged ‘letter of medical necessity’

ADMC stage to fight for a new manual wheelchair

In case I failed to previously outright say (crazy I want to be thought of as a person first and not the other mularky), the “condition” I live with is long term, from birth, not contagious, not hereditary, not terminal, not degenerative, and not autism. So now that I defined what is naught which is a lot easier and shorter than defining what Cerebral Palsy is, I’m just going to skip the “awareness and tolerance for those without disabilities” and grant you the ability to do an internet search on your own. I’m sure I’ll put up a post at some point where I’ve done this for you and unearth a mountain of decent internet resources to be clickity clicked.

Right now I am supposed to be getting my condo put back together after Hairy moved out, and after I re-arranged, and before I serve dinner. I checked my email hoping to get a response from some transfer advisor about that 504 accommodation request.  Nothing there. I did see a reply from the vendor who is doing the ordering for my new manual wheelchair. Which this has been going on for well over a year. I’ll skip the long winded backstory as much as possible.

 Assessment of wheelchair, wheelchair determined to be worth less than the cost of repair

 Dr. writes prescription, sends to vendor

 Physical therapist does a wheelchair evaluation which is sent to vendor and Dr who wrote prescription

 Dr. is supposed to agree or disagree in writing with the evaluation from the PT and inform the vendor

 Vendor takes measurements, writes quote.

 Patient or necessary people review the specs of the chair on the order

Vendor corrects the sloppy order written

 Letter of Medical Necessity written by the DR or PT is passed to vendor and submitted

 Vendor gets pre-approval from Medicare or Voc Rehab or other funding sources.

     ADMC stage

      Dispute or further justification of ADMC: why Ultralight wheelchair (coded as K0005) is needed instead of a Lightweight wheelchair (coded as K0004)

Why you can not use a K0004 manual wheelchair instead of the K0005 manual wheelchair.
They want to know what your ROM in your upper extremities is.
What is your strength in your upper extremities?
What is the patient history with neck. Shoulder, and arms?
They want to know why you can’t use a cane or a walker?

I understand this is to prevent Medical Suppliers from doing crappy work, or making false or padded claims, or prevent them and patients from trying to take advantage of the Medicare program. It’s crazy the amount of stuff I have to do and the things I am doing to get my DRs and PTs to provide documentation. I wrote the majority of the Letter of Medical Necessity and had the PT fill in the PT jargon he knew he had to include. Basically it’s me writing stuff to prove my need and getting the people with the degrees to re-write it on their official letterhead and harassing their staff to fax it and work with the vendor. I harass the vendor the most because the vendor has proven the most incompetent, and the PT and DR. are about equal in their incompetencies or neglect, imho.

… Maybe it is looking more like the end of 2013 before I see a new wheelchair. I had thought it would be Fall 2013 and maybe I was just doing the 504 Accommodation request for my school as what hopefully proved to be unnecessary, and now looks like I’ll have to change my tactic to how many semesters do I need to deal with requesting accommodations from the school while still waiting for my new wheelchair. I’ll save my sarcasm and jokes for another time. I was fooling myself when I thought the easy part of getting the vendor to make their order correct was the hard part. Not out of the woods just yet.  I hope it doesn’t turn into a situation where I will take bets between which will happen first: Graduate or Have a new wheelchair?

If you have input or insight of the process and time frame it takes to get a new custom, manual wheelchair and live in another state or another country, please leave a comment as I am  sure it would be interesting to compare the differences.

 

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