Paperwork

All my writing time today went to writing a Letter of Medical Necessity for the insurance company, to try to persuade them to pay for the features of my chair that I want and that cost extra. I also wrote a cover letter to go with it, to Vann, the medical supply rep I've been working with. I volunteered to write this letter, but I do expect him to edit it, and even for the doctor's office to edit it too. It should be on the doctor's stationery for one thing.

So, just to prove I was writing today - I'm going to paste both letters in here! This is dull stuff, I don't expect anyone to really read it, except hopefully the insurance company! They took 3 hours to write though. You would think it would be a no brainer that I need this stuff, but I am guessing that insurance will deny most of it.
Just to give a sense though of how much money we're talking about:
Base price of chair is $2995.
If I get one made of aluminum it could be $1000 less
Frogs legs with soft roll tires is $550
SPOX wheels are $695
Natural Fit handrims are $295
Marathon tires are $95
D's locks are $350
arm rests are $395
calf strap $35

The total cost of my chair as requested would be $5410.
But they could only agree to $1995 plus armrests and calf strap or $2425, which would mean I have almost $3000 out of pocket. It's worth pushing a little for insurance to pay for some of it!
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May 2, 2010

To Whom It May Concern:

The purpose of this letter is to explain the medical necessity for the wheelchair and its features being prescribed for our patient, Donna Petranovich.

Donna is a 52 year old woman, who has been a T1 -2 paraplegic since a gunshot injury when she was 15 years old. She uses her wheelchair approximately 18 hours a day, and is totally independent for mobility and ADLs. She is a self-propeller using a manual wheelchair.

In the past 2 years Donna has developed deQuervain’s tendonitis in her right wrist, which has not totally healed despite extended rest and 2 cortisone shots. She is currently considering surgery. This condition is caused by overuse of the wrists, with the primary stress from pushing the wheelchair, and secondary source from transfers in and out of the wheelchair.

Her current wheelchair was purchased in 2003 and many parts are currently in need of repair, plus there are many new features available now that will aid her mobility and independence, and reduce strain on her wrist. We recommend that she be using a lighter weight chair, specifically a Tilite 2GX chair.

Titanium – is being prescribed for lighter weight, a savings of 3 pounds over an aluminum chair, this will aid in self-propulsion and maintain independence.

Frogs Legs – are being prescribed to remove vibration in the frame of the chair, to eliminate bouncing that causes skin irritation and muscle spasms, and that makes propulsion more difficult. 80% of a wheelchair’s vibration comes in through the front forks. Anything that can make her propulsion easier, short of getting power-assist wheels, is being prescribed.

Soft Roll Front tires are needed for compatibility with the Frogs Legs.

SPOX rear wheels – are prescribed for lighter weight. A total of 3 pounds will be reduced by using SPOX, versus her current mag wheels. This will aid propulsion.

Marathon tires – are being prescribed for their higher pressure (80-90 lbs versus the more typical 40-50 lbs), which reduces rolling resistance during propulsion.

Natural Fit push rims are also being prescribed for ease in propulsion. With Donna’s recent problems with tendonitis, this is essential. The Natural Fits will make her hand grip better, and ease the strain on her wrist.

D’s Locks are being prescribed because they are the best at being unobtrusive and out of the way, as well as securing the wheel so that it cannot move when the chair is parked. At any given time Donna has several ‘quarter-size’ bruises along her right thigh in varying shades of purple, red, green and yellow, from transferring into her chair off the bed, toilet or shower seat. The cause is the handle of the lock she currently has, pressing against her thigh as she passes over it. Not only are the D’s locks more secure, but they can be located someplace less likely to cause injury, and they require the least strength to engage. Even when Donna’s hands and wrists are weak, she will be able to engage these brakes. These brakes do not add extra weight to the chair.

As a package we are prescribing the wheelchair that gives Donna the best chance of maintaining her independence with a standard manual wheelchair. We have considered prescribing power-assist wheels, but believe that if these features outlined above are provided that Donna not need to take that next step for some time to come.

If you have any further questions, please do not hesitate to contact us,

Sincerely,



________________________________________________________________________________________
Physical Therapist, Sharp Rehabilitation Outpatient Therapy
858-939-3082



________________________________________________________________________________________
Medical Director, Sharp Rehabilitation Center
858-939-4480

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Hello Vann,

Attached is my draft of a letter of medical necessity for my next wheelchair. Feel free to edit as you see fit. Then you will send it over to Nancy Stevens and Dr Stenehjem to sign, correct?

I have just a couple of thoughts/ questions that have come to mind after talking to you.

I am ok with not getting the fold down seat back. The more I thought about it, the less cost effective it seems. If I paid $165 or more for this feature, it would aid me about 2 times a year when I'm getting into a car with a tight fit. In Buenos Aires, where this was an issue last February and we took 2 taxis (one for people, one for wheelchair in the backseat) the extra cost was about $25. $165 is a lot of taxi rides! Most of the time it isn't needed. And, what I lose is that 365 days of the year I am pushing a bit more weight, and there's then one other part that can break. So, the GXSB5 is the right choice, and I won't be stewing on this anymore.

When I measured the length from the front edge of my seat sling to the top rear of my footrest, I'm getting 15 inches. I'm still don't really understand why you think I'm going to have a problem. The instructions say from seat sling to back of footrest, what were we doing when you were here? It was something measuring 16 inches, with 2 or 2 1/2 taken off for a thick cushion. But when I measure from heel to top of cushion I now am getting 18 inches, so I'm still puzzled. I think 15 inches is the right amount here, and I'm willing to take the risk I'm wrong if you put in 15 inches. Or we can meet again to remeasure if this is going to hard to adjust later. If you are having trouble trusting me on this one - try this out - my seat is now 18.5 inches from the floor, correct? If the measurement from seat to footplate were less than 14 inches, then my foot pedals would be 4 1/2 inches from the ground, since my feet are going almost directly down, correct? But at this moment, my heals are 3 1/4 inches off the floor - so I am sure I'm right!

Front angle 80 degrees, 2" taper, 15" footrest length, and flip up footrest - GXFTR1

Front wheels and Frogs Legs - see if you can get 4" x 1 1/2" when the order goes to Tilite, ok? soft roll tires. if they can only do 4" by 1" that's ok. Also, request red tires if you can too. I know Frogs legs makes them. It didn't ask anywhere for my weight -but put it down as 175 pounds, though at the moment I weigh around 168. I don't want the frogs legs undersized again! I assume that when the order goes into Tilite there is some place for comments?

Spinergy SPOX, change color to yellow.

SUMMARY:
2 changes:
footrest length is 15 inches
SPOX color yellow

1 request:
Frogs legs, red tires, 1 1/2" wide tires and makes sure they know my weight.

Hope this is all you need. Please send me copies of everything - order form, letter, prescription. I like to double check things, but I also like to keep copies for my records.

Thanks, talk to you soon,
Donna