Hello, I’m hoping for help here. I have an insurance company that denied coverage for a seat elevator for my power wheelchair on the basis that it is not primarily medical in nature (The seat elevator function is specifically excluded from the policy which states that the not-medical-nature is the grounds for the exclusion).
For me, I need the power seat elevator because I’m unable to transfer in/out of bed or to a public toilet without it. With it, I can. To me, that would be required for ADLs and make it necessary and effectively medical in nature.
Two questions-
1) Can anyone explain (honest question, not being sarcastic here) the logic of covering the power chair that doesn’t treat my condition, but allows for ADLs, but NOT covering the elevator that would allow me to use the chair without a PCA following me around? I’m hoping that understanding this can help me better advocate.
2) Any strategies to appeal? Based on the first appeal (I used one of two), the thing I need to fight is the “medical in nature” clause, so I need to make sure THAT is where I’m going with it.
I’m located in Minnesota in the US.
Thank you!
submitted by /u/gilder121
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Hello, I’m hoping for help here. I have an insurance company that denied coverage for a seat elevator for my power wheelchair on the basis that it is not primarily medical in nature (The seat elevator function is specifically excluded from the policy which states that the not-medical-nature is the grounds for the exclusion). For me, I need the power seat elevator because I’m unable to transfer in/out of bed or to a public toilet without it. With it, I can. To me, that would be required for ADLs and make it necessary and effectively medical in nature. Two questions- 1) Can anyone explain (honest question, not being sarcastic here) the logic of covering the power chair that doesn’t treat my condition, but allows for ADLs, but NOT covering the elevator that would allow me to use the chair without a PCA following me around? I’m hoping that understanding this can help me better advocate. 2) Any strategies to appeal? Based on the first appeal (I used one of two), the thing I need to fight is the “medical in nature” clause, so I need to make sure THAT is where I’m going with it. I’m located in Minnesota in the US. Thank you!
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