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True medical necessity

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Today I am feeling defeated....Anthem Blue Cross has DENIED the appeal for the standing feature for James wheel chair!!!! After a lengthy delay they have decided that this feature is not medically necessary. I provided supporting documentation from two physical therapist, along with his medical team at UCLA on why he needs this feature today, yet this individual (appeals person at Anthem) decided it's not necessary. Unfortunately for us this feature is medically coded as an accessory.
If you know James you know that he does not usually smile like he is in this picture regarding medical equipment or doctor visits.This standing feature of the wheel chair brought him pure joy when he test drove it. Although there are medical reasons why standing improves health, the pure independence and ability to be like his peers while in this wheel chair alone is enough reason for me to see the need.
I can not even begin to explain how our medical insurance has failed us in so many ways! I now have a dead line of March 30th (experation date for the purchase of the main body of the wheel chair) to make this $25,000 feature either magically approved, or paid for in full; or else the insurance will close the original request for the entire wheel chair. I refuse to give up this fight especially when James tells me every week that he can't wait for his new chair so he doesn't struggle anymore!
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Donations 

  • Patty Cuyan
    • $100 
    • 7 yrs
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Organizer and beneficiary

Chad Albaugh
Organizer
Benton, AR
Jamie Wilkes Albaugh
Beneficiary

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