Coming from a vendor this is one reason when people contact us we stress the
importance of having a team. This is something which sadly may be different
from vendor to vendor but I know at PRC it is part of the policy. When we
do not start with the team there then we do get stuck such as seen in this
case.
The only time I have seen someone obtain reimbursement after the device was
purchased was in cases they could have done retroactive. This though
requires the SLP to be part of the decision making process in the very
beginning. They then can help because during the decision process there
should have been a variety of different devices looked at and considered,
which is necessary for any funding.
I know the families just want to help their love on who has ALS, but
sometimes they are in the panic and jump the gun before making sure all of
the options were looked at.
Terese
Terese Phelps, M. Ed
Regional Consultant
Prentke Romich Company
1-800-262-1984 ext. 428
952-440-2041 office
xxxxxx@xxxxxxxxxxxx
www.prentrom.com
-----Original Message-----
From: xxxxxx@xxxxxxxxxxxxxxxxxxxx
[mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of Jane Huggins
Sent: Tuesday, December 11, 2007 11:23 AM
To: xxxxxx@xxxxxxxxxxxxxxxxxxxx
Subject: Re: [Assistive Technology] aac funding question
I doubt you have much of an option for getting reimbursement on the
present system. I do notice that the My TObii has some rental/trial
options. If that is how the family got it, then you might be able to go
ahead with the evaluation and recommendation. However, Medicare might
easily come back and say that the patient get a cheaper eyegaze system. I
think this is somewhat underhanded by Tobii, since their brochure for the
My Tobii system is absolutely plastered with statements that this is
Medicare approved. They should either be advising people in the proper
procedure or have a plan in place that doesn't violate that procedure.
I also sympathize with the family. This is a very expensive system and
getting funding can take a very long time when your loved one doesn't have
a lot of time left and needs the device now. But, I think that is what a
rental agreement would be for and the vendor should have recommended that
so that proper procedure could be followed.
On Tue, 11 Dec 2007, Molly Doyle wrote:
> We have had these types of requests in the past (not necessarily for
> this product). I assume the PALS is using the equipment & its meeting
> his needs. I empathize with the PALS and the family about wanting to
> get reimbursed but our center does not evaluate a person for a specific
> product particularly after that product has been received. We follow
> the steps outlined by Lew.
>
>
> Molly Doyle MS CCC
> CART-Rancho Los Amigos National Rehabilitation Center
> Downey CA 90242
> www.rancho.org/cart
>
> Please be advised that we cannot guarantee confidentiality of email
communications.
>
>
>
>>>> Alisa Brownlee <xxxxxx@xxxxxxxxx> 12/10/07 1:06 PM >>>
> A question for the AAC specialists of the group....
>
> We have a patient in NJ that paid out of pocket (and without an SLP
evaluation) for a My Tobii System from a local vendor. Now, the family
wants to apply to Medicare for partial reimbursement. (the 80% that Medicare
would pay for this device) The vendor is now asking one of the SLP's that
work with my Chapter to perform an AAC assessment based on this system then
submit the claim to Medicare. Has anyone on this list had this type of
request? Can a beneficiary request reimbursement for Medicare after the
fact?? (the patient has had the device for a few months)
>
> I asked Lew Golinker for advice (he is an attorney with the AT Law
Center) and he states the process of getting an eval, then script, then
submission of device has not been followed. However, I am wondering if
anyone else have faced this problem? I can't believe this is an isolated
incident and I was curious if anyone has any input to this or a similar
situation? (or has someone successfully done this type of "back ordering"
before?)
>
> 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
>
> ---------------------------------
> Never miss a thing. Make Yahoo your homepage.
>
>
> 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
>
>
> ---------------------------------
> Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it
now.
>
>
>
>
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Jane Huggins, Ph.D. "If God were small enough to be
understood, He would not be big enough
xxxxxx@xxxxxxxxx to be worshiped." -- Elizabeth Stone
%%%%%%%%%%%%%%%%% http://www-personal.umich.edu/~janeh %%%%%%%%%%%%%%%%%
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