Tuesday, May 21, 2013

How insurance paid for our home therapy equipment

We are a military family, so this entry will explain how we navigated through Tricare and ECHO to get several pieces of therapy equipment.  I hope this inspires you to learn what your insurance carrier will or will not provide.  Obviously, it is not something they are going to advertise or volunteer information about.  Please leave or a comment below if your insurance carrier assists you so that others may benefit from it.

First of all, we had to sign up for the extended portion of Tricare called ECHO.  ECHO stands for Extended Care Health Option.  From the website, http://www.tricare.mil/echo:  "ECHO is offered to the following beneficiaries who are diagnosed with moderate or severe mental retardation, a serious physical disability, or an extraordinary physical or psychological condition".  You must first be enrolled in the Exceptional Family Member Program ( http://www.militaryonesource.mil/efmp )within the military system before you will be considered for ECHO.  When I called the ECHO program initially, I was told it was "only for autism",  so I expressed my opinion, hung up, and called again.  I was then told that they didn't think she qualified.  I hung up and called a third time, and I was told "of course, let's get you going".  The paperwork was easy.  The monthly cost of ECHO is based on your rank, so $50/month for MAJ, and you only pay for the months you utilize it. So theoretically, all of this equipment will cost us $50.

After all of the paperwork was approved, I contacted the ECHO office again and found out which local equipment companies they will use here in Little Rock, AR.  (also know as DME providers which stands for durable medical equipment).  They will not pay for online purchases.  United Mobility and Equipment was accepted by ECHO. 

I then searched online for specific examples of products I wanted.  I was told to be approved it had to "promote development and prevent loss of function".  Finding products was the fun and easy part, I could pick out equipment all day long for my girls if someone else is going to pay for it.   Presley is almost two and is a good walker, so I focused on gross motor skills, climbing, muscle strengthening, and balance".  I chose several items thinking they would only pay for one or two. 

I then reviewed all of them with our Physical Therapist for her recommendations and opinion.  She was the greatest asset to our getting the equipment.  She wrote a letter of justification for each piece of equipment, explaining how Presley would benefit from each.  We then followed up with a letter of concurrence from Presley's Pediatrician too.  Then was submitted to the equipment company.  They researched the companies they ordered from to closely match the equipment we wanted.   

The equipment company then submitted the request to Tefra (Medicaid) to be denied.  Once denied, it could be submitted to Tricare (we have Prime).  Again, we were looking for a denial so it could be submitted to the ECHO, which pays for things traditional insurance will not.  I received a denial letter from Medicaid and Tricare, so that helped me track the progress.  Approximately six months after submission, I received a call that all the equipment had been delivered.  The equipment company representative was as surprised as I was that it was all approved and stated that they had never submitted such a request before. 

I am a true believer, that you don't know until you ask and they can only tell you no.  I wish you luck in your journey as you are your child's voice and advocate.  They deserve the best opportunities to succeed and sometimes it is with our time and efforts, and sometimes it is just being a kid by playing, exploring, and climbing.  Many blessings, Robin


 
Here are planks and steps that can be changed to various heights and positions. Called a "build  balance set".  Cost $480.
 
 
This is both girls favorite.  Presley immediately wanted me to hold her hands so she could follow her big sister around this.  We did this many times practicing her balancing skills.  
 
 
A straight line was lots of fun also. Presley immediately thought she could stand on it by herself.

 
This is called a round see saw.  It rocks while they stand or sit.  It also spins easy on carpet like a small merry go round.  Cost $304.

 
Presley loves climbing the steps and slide.  Within a couple of days, she began sliding while sitting upright.  Previously, she would always lay down on her belly and slide backwards.  It takes up quite a bit of space, but worth it. This particular one is called a corner climber with slide and costs around $900.

 
Soft balance beam.  This one is good, but I would chose the other one for balance if you can only get one .  Cost $236.
 
 

 
This is called a "dizzy disc".  It spins the child around and different angles can be added for various sensory input. .  Cost $282.  However, our neurodevelopmentalist did not approve this or using the round see saw as a merry go round since Presley has specific spinning exercises for her nystagmus and other developmental issues, so check with your program manager for their suggestions if you are using one of the neurodevelopmental programs. 
 
 
The last item is the "rainy day platform swing" with 29:-36" support bar.  Cost $ $393 and $197.  I have not set this up since we have ran out of space currently, and we hope to start building a new home in the future with a larger dedicated space for all of this.  How could this not be fun though?
 
 


 
 
 
 

3 comments:

  1. Such a helpful article for military families. I hope a lot of people see it.

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    Replies
    1. Thank you and good luck! Now they can't tell you it can not be done. :-)

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