e-stim and insurance coverage

[Andrea]

I have UHC and they denied a NMES unit for my daughter. They say it states in my summary description for work that e-stim is not a safe and effective treatment for brachial plexus injuries. That is funny because I didn't know my work place had special section for brachial plexus injuries..hehehe just being funny. But, to get back the questions..I was wondering if anyone has any documentations regarding estiming and brachial plexus injuries. My daughter has had 4 surgeries and everytime we have e-stim her after the surgeries and the outcome has been good. I totally beileve in e-stim and believes it does work on children w/bpi. I have a couple calls into BPI specialist and just wanted to jump on this so that I can appeal the insurance company. Thanks!

[hope16_05]

Well I have been using E-STIM since July, and along with some other therapy I have made amazing gains. I can get coppies of my progress if it will help and email it to you. I have been able to do me hair and do push ups, my new record is 20(from my knees) as to the half of one I used to be able to do. If it is used right It is very safe and very useful! I dont always check here every day, so email me at hope16_05@hotmail, if you have questions or you want my OT records for E-STIM
Amy, 18 ROBPI

[admin]

We have UHC and they have approved NMES. The total cost is something like 188.00 per month, but we pay like 66.00 or something. They cover the rest. I am looking into a rent to own with Empi so that we are not just spending this money every month, we will hopefully have a machine in the end. I love UHC, they have been great with everything except therapy. My child has been prescribed more therapy than our policy allows(20 OT per year and 20 PT per year-not near enough). We are in the process of trying to get the stuff together to appeal that. By the way, we have Choice Plus, if that matters. I am sorry that you are having trouble getting coverage. We have seen an improvement since we began NMES. Oh, what company are you going with for NMES? I don't know how many companies there are that make those machines, but we have had not a minutes trouble with getting coverage for Empi. Good luck to you, please let me know if I may be of further assistance.

[admin]

I have UHC insurance and they said they would pay for the unit because it is durable medical equipment. You need to get a script from your Dr. and it should work.

However, the unit our Dr. wanted us to get, we couldnt get that type through the providers through our insurance so we ended up just forgetting it and buying it out of pocket...It was such a hassle just to find out anything...and I didnt have or want to wait all that long to get my child started on e stim so we just went ahead and bought it. The cost of our unit out of pocket wasnt too much...around $150.00 but Im sure there is more very expensive ones.. but our Dr. told us this was what she used in her office and it would be fine to use. Hope this helps...

[myhumanrevolution]

We have MVP in NY and they have denied our estim unit as well. They said Douglas needs PT...Hello....he's getting that too of course! I think I should get a special credit card just for Douglas' medical expenses.... There are so many things that are adding up quickly....

You can ask the estim unit company about a payment plan....and then put the payments on a credit card if need be.

How do people deal with all these expenses?

Jennie

[admin]

My insurance covered it. We got a very strong letter of medical necessity. Our unit was $1500 if we went through insurance and $750 if we paid cash, so we paid cash and then our insurance reimbursed us. I had to fight for a while but the fight went through. I printed up tons of stuff about the benefits of e-stim and they probbably didn't read any of it but the squeaky wheel syndrome. So that's what I would suggest, become a loud squeaky wheel.

It really bothers me that we all have health insurance and pay so much for it (ours is $12,000 a year) and yet we can't get it to pay for much. What's THAT all about? So I just fight like the dickens for everything and I end up getting almost everything.

[myhumanrevolution]

Well it turns out our insurance MVP HMO came through! We won the appeal! They are paying for our NT 2000 afterall!!!!!!! Woooohoooo!

They also payed for the Mod Quad with Dr Nath.

And I decided to take the BOTOX to the next round of appeals! You never know!

Jennie

[admin]

Jennie! Great job!! Squeaky Wheel works wonders!

[admin]

Hi Andrea,
We got James unit under durable medical. Our therapist had to call the company and find out what company they would pay for. once we found that out there was no problem

[admin]

I thought it would go under durable equipment also and the insurance company is indicating not. I spoke w/TX and they are going to send me a letter of medical necessity. My therapist is going to write a letter and contact another BPI specialist and see if they have any documentation. So, hopefully that will work. Keep your fingers cross for me!

Thanks,

Andrea