I'd ask, on what grounds are they making that judgement? are
they RECOMMENDING a 'less deluxe device' - (if so, what are
their credentials???)

As you know, avoid using the word "best" (which you used in
your email to the list, but we know you meant "least costly
medically necessary and appropriate option")!

And, thanks for reminding us all - when denied, APPEAL!

Amy



---- Original message ----
>Date: Thu, 3 Apr 2008 18:42:59 -0700 (PDT)
>From: Alisa Brownlee
>Subject: [Assistive Technology] insurance question
>To: ALSA Listserv
>
> Question for the group:
>
> We recently had an AAC device denied from Blue Cross
> for one of our PALS. We are appealing this decision
> and I was hoping someone in the group has some
> strong wording that has proven successful with
> insurance appeals that we could incorporate into the
> appeal letter.
>
> This patient is a quad with decent head control. We
> documented that we tried the ERICA system which was
> not successful, (patient wears special bifocals and
> the camera could not capture her eye movements and
> she could not see the screen without glasses) the
> Dynawrite and scanning Lightwriter with switch
> scanning which was slow and fatiguing, and the DV5
> with headmouse which was quicker in terms of access
> versus the above devices. We documented "that the
> Dynavox DV5 Max offered all the features she wanted
> and Mrs. XX reported it was more comfortable and
> less fatiguing to use the head mouse as opposed to
> using a switch. Using the Dynavox V Max with a head
> mouse system, Mrs. XX was able to fully utilize all
> the features on the device. Mrs. XX was very
> successful using the headmouse system with on-screen
> keyboard display and was able to cover the entire
> quadrant of the screen. Upon successful set up of
> the head mouse and communication device, Mrs. XX was
> able to independently utilize the Dynavox V Max
> system to communicate her needs."
>
> Blue Cross denied this device stating a "less deluxe
> speech generating device should be sufficient to
> meet this member's basic communication needs".
> (personal note here--my husband says I should tell
> Blue Cross that smoke signals are no longer
> recognized as a sufficient communication system but
> I don't think they would get the joke)
>
> So, I am asking the group for any good wording
> because I think we did a decent job documenting that
> this was the best device for her communication
> needs. Any help will be appreciated. You can email
> the group or me directly at
> xxxxxx@xxxxxxxxxxxxxxxxxxxx
>
> Many thanks,
> Alisa
>
>
>
> Alisa Brownlee, ATP
> Assistive Technology Specialist
> ALS (Lou Gehrig's Disease) Association, Greater
> Philadelphia Chapter
>
> Assistive Technology Consultant, ALS Association,
> National Office
> Direct Phone Number: 215-631-1877
>
>
>
> ------------------------------------------------
>
> You rock. That's why Blockbuster's offering you one
> month of Blockbuster Total Access, No Cost.


Amy S. Goldman, Associate Director
Institute on Disabilities
Temple University

CELEBRATING 10 YEARS OF PA'S ASSISTIVE TECHNOLOGY LENDING LIBRARY!

http://disabilities.temple.edu
215-204-3862 voice direct
215-204-9371 fax
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