If you are trying to get your insurance company to pay for an electric wheelchair or wheelchair accessories that can make it easier for you to be mobile, it can be demoralizing to receive an electric wheelchair and accessories insurance denial. Life can be difficult enough when you require a wheelchair or other accessory because of a disability. Many people simply do not have sufficient upper body strength to operate a wheelchair with only their arms, especially the elderly. This means they are dependent on others to push their wheelchair, losing much of their independence. An electric wheelchair can return this independence, allowing an individual in a wheelchair to go where they want when they want.
If you have received an electric wheelchair and accessories insurance denial, you need a strong legal advocate to fight this fight for you. At the Law Offices of Scott Glovsky, we fight for those who are so tired of fighting they are ready to give up. Attorney Scott Glovsky will ensure your insurance company is not denying your electric wheelchair simply because of the cost. If appeals are necessary, Scott can help you. You do not have to simply accept the insurance company’s decision—you have rights, and Scott will ensure those rights are protected.
What Medical Issues Benefit from an Electric Wheelchair?
If you believe you could benefit from having an electric wheelchair or scooter, you must first speak to your doctor or primary care provider. If your PCP agrees that an electric wheelchair is medically necessary, they will sign an order or prescription for the wheelchair. The order will state that your health makes it generally difficult to move around in your home, or outside your home even with the assistance of a cane or walker.
The prescription or order will further state that it is difficult for you to perform everyday tasks like bathing and dressing and that you cannot use a manual wheelchair due to physical limitations. If the electric wheelchair will help with a specific medical condition and will be used primarily in your home, then the order will state this. You must have an in-person meeting with your doctor before a prescription for an electric wheelchair can be written.
Physicians order wheelchairs to assist individuals with many conditions including autism, neurological and autoimmune disorders such as ALS and multiple sclerosis, neuromuscular disorders like cerebral palsy, genetic diseases like muscular dystrophy, musculoskeletal issues such as amputation, and others.
The benefits of electric wheelchairs are numerous, primarily because electric wheelchairs give the user independence. Electric wheelchairs are easier to use than manual wheelchairs, requiring much less effort, and allow the user to sit in a more upright position which helps those who suffer from back pain.
Why Might a Request for an Electric Wheelchair Be Denied?
Unless your insurance specifically states that they will not pay for an electric wheelchair, your denial letter likely states that an electric wheelchair is not medically necessary for your medical condition. What this actually means is that it does not want to pay for an electric wheelchair if it can possibly avoid it. An electric wheelchair can cost as much as $8,000, as compared to a manual wheelchair, which costs about $300. The issue is whether an electric wheelchair will benefit you and give you back some of the independence you have lost. If you receive an electric wheelchair and accessories denial, you do have options.
What Can You Do if You Receive an Electric Wheelchair and Accessories Denial?
After receiving a denial for your electric wheelchair, you should immediately contact an insurance denial lawyer like attorney Scott Glovsky. You can file your own appeals, but the process can be difficult and time-consuming. While it is hardly fair, insurance companies sometimes pay more attention to an individual who is legally represented. Your attorney can assist with an internal appeal that simply asks the insurance company to reconsider its denial decision.
You may be asked to obtain a letter from your doctor that further explains why you would benefit from having an electric wheelchair. The insurance company may decide to approve the request or may deny it again. At this point, your attorney will guide you on the appropriate next steps – filing an external appeal or taking legal action. In an external appeal, a neutral third party will consider all the facts and look at all the paperwork from your doctor. If the external appeal is successful, the insurance company will have to pay for your electric wheelchair.
What Insurance Companies May Deny Your Request for an Electric Wheelchair?
In 2021, Kaiser faced challenges over its decision to only pay up to $2,000 for an electric wheelchair intended for home use. The argument was that an insurance benefit that only provides enough coverage to stay home, not work, and not leave one’s home is discrimination rather than a real benefit. Carly Myers, Staff Attorney at Disability Rights Education & Defense Fund (DREDF), stated that basic human rights were the issue and that “without the tools they need to become mobile, justice is denied.” Other insurance companies may also deny a request for an electric wheelchair, including:
- Anthem Blue Cross
- Blue Shield
- Health Net
- Kaiser
- United Healthcare
- Aetna
- Medi-Cal Managed Care Plans (Anthem Blue Cross, Promise Health Plan, Health Net, Molina)
How the Law Offices of Scott Glovsky Can Help
If you or a loved one has received an insurance denial for an electric wheelchair and accessories, you need help, and you need it quickly. Attorney Scott Glovsky and his legal team are ready to help you get what you need for mobility and independence. It is simply insulting to find that the corporation you faithfully make monthly payments to is the first one to turn its back on you. Remember—you only need one person who cares enough to advocate on your behalf and to go to battle with big insurance companies. Do not give up—the Law Offices of Scott Glovsky is ready to help you through this difficult time. Contact the Law Offices of Scott Glovsky today.