Hi everyone,

 

I am asking for feeback on the following information that I was given from a funding coordinator at Dynavox today.  I have her permission to ask the group for their reactions and to see if this is happening with some of your submissions for SGD funding. 

 

Problem is with Medicare and not funding a device based on a client's intelligibility.  Upon correspondence with this funding person, she informed me of a recent denial from Medicare that I have attached.  (SLP documented that the person with ALS had a 70% intelligibility)  The denial letter indicates that since this person can still make themselves verbally understood, they don't qualify for an SGD. 

 

Anyone have denials like this??? 

 

I am not sure what type of wording we need to use now because if CMS is considering the fact that someone can still make themselves verbally understood, regardless of fatigue or dysarthria, then when is someone to use an SGD?? When they have no vocalizations at all??

 

Feedback appreciated....

 

Thanks,

Alisa

 

 

Alisa Brownlee, ATP
Clinical Manager, Assistive Technology Services
ALS (Lou Gehrig's Disease) Association, Greater Philadelphia Chapter

 

Assistive Technology Consultant, ALS Association, National Office

Direct Phone Number: 215-631-1877