Thursday, January 8, 2009

Doublespeak 101

At this time Keith has a hydraulic hand-powered lift which requires someone with the upper body strength to guide Keith into his wheelchair. It's really a two-person operation since one person has to move the ventilator and the other person needs to be sure that the single lever that locks the sling in place does not come loose. This has happened twice so far, quickly dropping Keith towards the floor and if a 2nd person hadn't been there, he would have had quite a jolt.

So, we were heartened to receive an email from Michelle that she'd investigated on her end and found that there was a possibility that Keith could qualify for a motorized lift. This is a key piece of equipment because it allows Keith to get out of bed and back into his life.

I contacted our insurance-approved durable goods provider and received this response:

Are you talking about a patient lift? If so (I am ccn'g our billing specialist to get more input as well) while they may authorize the electric lift, history has shown that when we submit our claim for payment they downgrade the claim payment to a manual patient lift, and pay us based on that code despite getting the auth for a power lift. It is rather frustrating, but the reasoning is, a power lift is a convenience item for the caregiver, and not for the patient, unless the patient is using it independently, in which case that point has to be proven, by the fact that no caregivers are on staff for the patient.

Next problem is, if they ever would pay us one time, which so far they haven't that I am aware of, the allowable for a power patient lift is very low. First Medicare will only pay for that item as a rental, they cap that rental at 13 months, so for $128.48, it would take us 13 months to capture $1,670.24, and that is if the secondary insurance kicked in otherwise it is only 80 % of that amount. As you know the power lifts cost as much as $2,500 and more. There is no way we can purchase a $2,500 lift and expect to get paid $1,670 after one year of billing, if they were to pay us at all, which again they would more than likely down code the item to a manual lift.

I am sorry to say, unless our billing specialist knows something I don't, I don't think we can help you with your request, unless you have some other type of funding source willing to pay for it, such as DARS.

We heard from the billing specialist today and she confirmed that nobody has been successful in this mission in the past and there is no expectation that anyone would be successful in the future.

The most frustrating thing about this is that this piece of equipment is vital to Keith's continued recovery. One of the symptoms of Spinal Muscular Atrophy is muscular wasting. Keith always had a very active life that slowed the muscular degeneration, but after 10 months of enforced bed rest, this thin line between maintaining and losing overall health has been irrevocably erased. Unlike people without SMA, Keith cannnot rebuild muscle strength. Add to this the stress of being forced to disconnect from the meaningful engagement with the world that Keith has had his entire life and you begin to understand the importance of this piece of equipment.

The motorized lift is not a "convenience to the caregiver". It is a vital tool that allows Keith to actively participate in his life. When he gets out of bed and into his wheelchair, he reclaims his independence and his whole perspective on his role in the world. The importance of this cannot be understated and we will continue to pursue every avenue to get what we need for Keith to reclaim his life.

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