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Old 07-27-2012, 10:26 AM   #11
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I am curious as well. If the need for a mobility aide was indeed warrented, and prescribed by the health care provider, and then ordered and paid for by the insurance company, I see no problem at this point.

Then, if the owner decides that a different mobility aide was better, and the insurance company decided that it was not covered, I do not see how there is fraud in selling one, to get the other. (Segway or not)

Of course, if at some point in the future, you go back to the insurance company for another wheel chair, it would be completely fair for them to ask what happened to the last one, or to deny on the grounds that they already gave you one.

I have permanent and debilitating damage to my right knee, (and resulting complimentary damage to other joints) and have been prescribed and given many different aides over the years that either wear out, or I out grow the need for or several other reasons for their eventual non-use. No current need for a device has been precluded for a previous other device... yet. Luckily for me, I have been able to compensate biologically more often than not, but each year it gets harder, and I surely have good days/weeks/months and alternately, I have bad days/weeks/months.

It would be an interesting test case, that I do not have the guts to try.
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Old 07-27-2012, 02:17 PM   #12
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I would suggest anyone in this position should talk to an actual lawyer before either proceeding or rejecting the idea.

I myself cannot construct an argument that this could be fraud, for precisely the reasons eJK gave. But that doesn't give me any confidence that someone wouldn't view it otherwise try to cause trouble.

And trouble is all to easy to cause.

I've seen the issue raised with donating medications, but there the argument becomes that you accepted the item on behalf of someone not covered.
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Old 07-27-2012, 02:26 PM   #13
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Originally Posted by Bob.Kerns View Post
I would suggest anyone in this position should talk to an actual lawyer before either proceeding or rejecting the idea.
Very sage advice to heed...As it was offered

"Isn't there a way to work around that insurance thing? How 'bout the doc prescribes a motorized wheelchair or a 3/4-wheel scooter. Then you pick up the device and promptly sell it and put that money toward the cost of a Segway."

I would be unable to view it as anything but fraud.

Call your Insurance provider and explain to them your intent. I'm certain they'll give you a very clear answer.

That of course doesn't mean you can't sell an old scooter or wheelchair and apply those funds to something else.
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Old 07-27-2012, 03:08 PM   #14
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That of course doesn't mean you can't sell an old scooter or wheelchair and apply those funds to something else.
But who determines the age cut-off? If I can sell a 5 year old device, why can't I sell a 1-year old device? "Old" is subjective.
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Old 07-27-2012, 04:44 PM   #15
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But who determines the age cut-off? If I can sell a 5 year old device, why can't I sell a 1-year old device? "Old" is subjective.
I don't know the answer to these questions either. It is quite possible to "outgrow" a device--in either direction. If it is no longer needed and your insurance premiums paid for it...
And then of course there is the question of who will determine those matters of need as well as age of the device.
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Old 07-27-2012, 08:22 PM   #16
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Very sage advice to heed...As it was offered

"Isn't there a way to work around that insurance thing? How 'bout the doc prescribes a motorized wheelchair or a 3/4-wheel scooter. Then you pick up the device and promptly sell it and put that money toward the cost of a Segway."

I would be unable to view it as anything but fraud.

Call your Insurance provider and explain to them your intent. I'm certain they'll give you a very clear answer.

That of course doesn't mean you can't sell an old scooter or wheelchair and apply those funds to something else.
I understand where you're coming from here, but:

1) insurance companies will of course give you the answer they want to give you. That doesn't mean it's the right answer. If you care enough to be considering such measures, you're better off with an advocate who has your best interests at heart, and that is definitely NOT the insurance company.

2) Docs game the system on behalf of their patients all the time. It is a perpetual ethical quandary for them. (And we should also raise the question not just of fraud -- a legal concept -- but also ethics, in both medical and moral senses). Docs are forever choosing ICD-9 codes on the basis of what they believe will lead the insurance pay for the procedure or test or treatment that they believe are what the patient needs.

Insurance companies are not "the good guys". Long gone are the days when Blue Cross was a mutual insurance company looking out for its members -- and even then, insurance inherently pits the recipient vs everyone else, when it comes time to pay claims.

I DO believe there is a line here. But I don't know where it lies, legally, ethically, morally, and even if I thought I did, I wouldn't know how to describe it in a way that would let anyone apply it to their specific circumstance.

Hence, my advice -- talk to a lawyer, either way. The line may not be where you think it is. It probably varies by jurisdiction. It may vary by insurance contract terms.

BUT -- along the lines of what you're pointing out -- if you get the device, sell it, buy a Segway, and end up with more money than you put in -- I don't know about the legal situation, but I'll raise moral objections to that.

Even though it's the insurance company's fault.

But if you refund them the difference?
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Old 07-27-2012, 09:53 PM   #17
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As Bob points out, there are ethical questions here, as well as legal ones.

I can only imagine that if you intentionally get the insurance company to give you a device that do not plan to use, but to sell instead, it sounds like fraud to me, or at least against the policy, if not the law.

There is a difference here not so much in the time frames, but the intention. If you have a mobility device that the insurance paid for, (Yesterday, last month, last year...) and it is not what you need, and they will not pay you to get what you do need, that is different than the preceding paragraph.

So, it seems to me not so much the what you do, but if you plan to defraud the insurance company, you probably are.

As far as finding a lawyer to help you with advice as to the laws, I agree it is a good idea. If looking for a lawyer to help you determine if it is within the law, but against the insurance policy, also good.

If you are looking for a lawyer to help you with this ethical dilemma, I feel you may be looking for a very, very long time before you find one able to appropriately weigh in.
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Old 07-27-2012, 10:45 PM   #18
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I sure hope we are not going to turn this discussion into anything resembling accusations of conspiracy to defraud. My questions were legitimate curiosity. I don't have an insurance company, I have only VA health care. Each and every device I have gotten from them for my health care "needs" were prescribed, not requested and some even landed on my stoop with me initially wondering how and why they were sent.

Like the shower seat. I remember my doctor asking about whether I run out of breath showering (yes) and do I have a seat in my shower (no), but it didn't sound like anything more than just Q&A. Two weeks later, I have a plastic and aluminum shower seat that I have never used.

So, would it be fraud to sell it at a yard sale for 5 bucks? What if I sold the nebulizer they won't take back?

What is ethics anyway? I know there are many common ethics we all share - don't steal, don't shoot the neighborhood brats, etc. - but our idea of ethical health treatment may vary. I think some medical treatment should be legal. Some states agree, but the federal government don't. I think Segway's should be prescribed for certain conditions, but because Segway INC won't put that label on it, the insurance companies don't allow it as a legitimate claim. INCs business dealings and agreements with a company that cares more about profit than quality of life for its customers is unethical to me, but you or others may disagree.

I was asking about actual rules, regulations and law. I realize we may not be graced with any Segging attorneys that can answer these questions, so I was hoping for "best guess" scenarios. But nothing I said should be misconstrued as a conspiracy to defraud, or even to be unethical in my actions or inaction. Of course, to a small number, just posting my thoughts on SegwayChat is unethical, or at least a lapse in good judgement on my part.

Please, let's not digress. Let's assume everyone participating has the best of intentions and just wants to be better informed.

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Old 07-28-2012, 03:37 PM   #19
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Quote:
Originally Posted by Bob.Kerns View Post
I understand where you're coming from here, but:

1) insurance companies will of course give you the answer they want to give you. That doesn't mean it's the right answer. If you care enough to be considering such measures, you're better off with an advocate who has your best interests at heart, and that is definitely NOT the insurance company.

2) Docs game the system on behalf of their patients all the time. It is a perpetual ethical quandary for them. (And we should also raise the question not just of fraud -- a legal concept -- but also ethics, in both medical and moral senses). Docs are forever choosing ICD-9 codes on the basis of what they believe will lead the insurance pay for the procedure or test or treatment that they believe are what the patient needs.

Insurance companies are not "the good guys". Long gone are the days when Blue Cross was a mutual insurance company looking out for its members -- and even then, insurance inherently pits the recipient vs everyone else, when it comes time to pay claims.

I DO believe there is a line here. But I don't know where it lies, legally, ethically, morally, and even if I thought I did, I wouldn't know how to describe it in a way that would let anyone apply it to their specific circumstance.

Hence, my advice -- talk to a lawyer, either way. The line may not be where you think it is. It probably varies by jurisdiction. It may vary by insurance contract terms.

BUT -- along the lines of what you're pointing out -- if you get the device, sell it, buy a Segway, and end up with more money than you put in -- I don't know about the legal situation, but I'll raise moral objections to that.

Even though it's the insurance company's fault.

But if you refund them the difference?
Perhaps I misunderstood the stated intent. My perception of the statement

"Isn't there a way to work around that insurance thing? How 'bout the doc prescribes a motorized wheelchair or a 3/4-wheel scooter. Then you pick up the device and promptly sell it and put that money toward the cost of a Segway."

was that one would accept the physician prescribed device with the sole intention of selling it to acquire something that the paying entity was not contractually obligated to pay for.

That my friend is a fraudulent activity, there is no way in my mind to justify it.

If you aren't happy that Segways aren't a covered benefit ( i'm certainly not) lobby your state and federal lawmakers, appeal to the insurance carriers, start your own cooperative efforts. A group of us early adopters here on Segwaychat collectively bought a Segway for a young man.

But for heavens sake don't twist ethics in some perverse way to justify illegal behavior no matter how difficult it would be to prove.
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Old 07-28-2012, 04:04 PM   #20
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The example I gave was not one where the patient ASKED for an approved mobility aide just so he could use it to get a Segway. The doctor prescribed the device of his/her own volition. If a patient feels their quality of life would be better by using a Segway instead of a wheelchair, why do you feel it is fraudulent to take the matter into their own hands.

What if the patient paid for the Segway with his/her own funds and the wheelchair languished in storage for some time. Then it was sold at some later date. Is that fraud? It's pretty much the same thing. The question still remains, what has the length of time to do with it? And who determines that length of time?

To set any minds at ease, I have a Segway that is bought and paid for with private money. No doctor has prescribed a mobility aide for me based on my disability (except for the crutches, cane and knee braces for injuries I mentioned previously). I am not looking for a way to get a Segway for myself, I already have one.

Please keep in mind that I am trying to figure out if there are any legal ways for a disabled person to obtain the mobility device of their choosing. I am NOT trying to justify any illegal or immoral act. Leave the damn insults and accusations out of the discussion, please.

Jim
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