Testimonials - Please help me out

[terhorstj]

Hi everybody,
As I'm sure many of you are aware, I have been trying to get my insurance company (who claims to cover the Segway HT as medically necessary personal assistive mobility devices) to reimburse me for my Segway. We are currently entering into an appeals process and I am trying to collect documentation regarding scientific, social, and most importantly, medical, impact of the Segway on the lives of those with disabilities.
I would like to ask anybody who would feel comfortable volunteering their stories or testimonials to please do so. I am an AVM (stroke) victim who has nerve damage at the brain stem / spinal cord, and so stories of that nature would necessarily be most poignant. Also, if you happen to have any supplemental material regarding this (clinical studies, medical journal communications, etc), please post those here, link them, or e-mail me (my address is given below).
If you would feel more comfortable e-mailing me instead of posting here, you may do so. My e-mail address is terhorstj@gmail.com. I will keep all submissions anonymous!

Thank you all,
Sincerely,
John

[cmonkey]

Have you checked out the testimonials on DRAFT?

http://www.draft.org/draft3/

[terhorstj]

Yes, thanks though!

[jimbo74]

John,

I'm afraid I'm not going to be of any immediately tangible help, such as you are requesting, but did want to let you know that I feel for your plight and am hoping that someone else comes through for you. (I've followed your RX for Seg thread on DRAFT) I am a "newbie" in the Segway world (though I try to be a well informed newbie) and also have a neurological, spinal cord, related health situation and have in my 1 week intensive test of a rented i167 recently determined that a Segway is the IDEAL assisitive mobility device for me. I am "pre-wheelchair" and have enough balance where I can even stand on one leg at a time for a second or two, but am weak with a diffuse muscle paralysis bodywide which makes everything including walking a carefully orchestrated (but fairly "normal" from an observer's perspective) nearly "intentional" event. I find that the Segway allows one not only the regained delight of agile movement, but an actual core trunk muscle strengthening occurs which both relieves pain. maintains muscle tone in this critical area, AND dramatically uplifts your spirit resulting in increased appetitite and sleep quality.

My DR. enthusiastically supports my potential use of a Segway, has provided me with an RX for one, and I await the "support document" which Medicare requires from him for the purchase of a POV/PMD. (scooter or wheechair) The very likely ultimate roadblock to reimbursement in my case is the DME (Durable Medical Equipment) designation which Medicare requires. The Segway just doesn't fit it, no way around that. If it did, I would still need a unique "code" for the Segway that would be provided by a medical supplier, and as you know medical suppliers don't get (as in have experience with) and or can't sell a Segway. (It not being FDA approved)

As you have private insurance which you indicate "claims to cover the Segway" you may have a much better chance than do I (though there are other circumstances in mine I won't go into) and I'd be interested in knowing a bit more regarding the circumstances of your appeal. (I appealed an insurance company on a denial of benefits for a unique breathing machine many years back and WON the 14k device after providing the supporting documentation in an appropriate manner) I have done research in this area but each persons situation is different.

The intention of my post is to provide you with some support so don't be at all discouraged by my situation. (and DO be encouraged by the fact that I did WIN an appeal with an insurance company ) I'd be very pleased if what I've learned might help you. I know you already have this but the 68 page "Testimony to the National Parks" carried out by Jerry Kerr on DRAFT is the BEST support document I can think of which might help your cause as regards the specifically unique aspects of a Segway for you as well as prominent (and not) individuals who use one so successfully as mobility aids in ther lives.
http://www.draft.org/draft3/DRAFTArticlesLetters/CongressionalTestimony/tabid/97/Default.aspx

I'm rooting for you and please ask if their is anything I might do that can help you.

Jimbo74

[terhorstj]

Thanks, Jim, this is all good information. I think we are both aware of the same road-blocks. Don't worry - I will post here with any new information as soon as I get it. We are currently waiting to hear from the insurance company about the details regarding why my case was denied.


John

[terhorstj]

We got the denial paper.

They specifically referred me to this item in their General Exclusions list:

“Over the counter Equipment for non-prescription [over the counter] medical equipment or supplies that can be purchased without a licensed provider’s prescription order, even if licensed provider writes a prescription order for a non-prescription item, except as specifically provided in the Evidence of Coverage.”

I’m not sure what that means; we will call the broker on Monday. It seems to me, that the best evidence we have is the document where the Segway was listed as DME...

More info later...

[Desert_Seg]

..“Over the counter Equipment for non-prescription [over the counter] medical equipment or supplies that can be purchased without a licensed provider’s prescription order, even if licensed provider writes a prescription order for a non-prescription item, except as specifically provided in the Evidence of Coverage.”...

Now that's a good catch all (ban all?) clause.

It basically says that if you don't need a presecription to buy it they don't have to cover it.

This is just like a clause that we put in all our employment contracts "and any duties as assigned"

Steven

[jayrogo]

A handful of our customers are like you. They have disabilities that can get them a wheel chair or rascal scooter thru their insurance at no cost.
But when it comes to a Segway, no. The insurance companies have no problems with the Segway or it's use by disabled, but will not reimburse.
Our customers got their doctors to update their handicap parking card to say "uses Segway for mobility."