Doing the Insurance Dance

Inspired by Mitch over at Enjoying The Ride, here’s my crazy insurance story. Granted, this is a completely “first world problem,” but I was surprised (though maybe I shouldn’t have been?) by the tom-foolery.

I’d been struggling to drive my wheelchair around the house. The chair was, as I have since discovered, essentially a fancy transport chair. As much as I loved it, and as well as it served me (making several trips to Florida and one to Switzerland, and countless excursions into Portland), it was always a bear to self-propel. I ended up with constant pain in my shoulders and elbows. My neurologist wrote me a prescription for a power chair. I found this one, which I liked because it could be broken down and loaded into the back of my wife’s Subaru, allowing me power-chair-access to the wider world. (The fact that it didn’t end up filling that expectation very well is beside the point.) When I first approached Anthem for a pre-approval, I blithely told them I wanted this particular chair because it was reasonably portable, and would allow me that out-and-about freedom. The person I spoke with told me, flatly, that they only covered powered vehicles for inside the house, that getting out was not a considereation for them. I argued that quality of life was a health concern (wasn’t it?), and was told that no, it wasn’t, at least not for them. I was livid and confused.

Fast forward a month or so. My local supplier, Black Bear Medical, came up with a new insurance number, and I resubmitted the claim. The only difference was this time, I did not volunteer any information about why I wanted this particular chair – they didn’t ask, and I didn’t tell. Bingo! Chair purchase approved. The exact same chair that they had denied only a month before suddenly was now acceptable. Apparently, “don’t ask, don’t tell,” applies to more than just sexuality in the military.

I went back to Black Bear a year or so ago, shopping for a scooter, for which I also had a prescription from my neurologist. I mentioned the previous power chair coverage issue with the salesman at Black Bear, and asked him if would have the same issue with the scooter. He shook his head with a rueful smile and said that this was a game that the insurance companies played. In the case of the scooter, all parties involved knew full well that this was not an item one purchased for use around the home, but that the same “don’t ask don’t tell,” game applied here. They would most likely cover the purchase of a scooter without flinching as long as I made no mention of the fact that I wanted it for use outside my home. Chances are they would not ask, even though they knew as well as I did this was what it would be for.

As it turns out, I did not purchase the scooter. But I am looking at an accessory drive system to add to my new wheelchair (which Medicare paid almost all of), which, according to the information I’ve seen online about this item, would vastly improve the drivability of my new chair and alleviate shoulder, back , elbow, wrist and muscle fatigue issues. Their website also talks about their products being at least partially covered by Medicare. My next step is to extract prescriptions from my physical therapist and my neurologist that this accessory is medically necessary. And then, I can hold my breath and dive back into the deep dark depths of the insurance claim industry, and see what happens.

Either that, or it’s Go Fund Me time.

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