Need help form anyone who may have used the $2000 MDA funds towards purchase of mobility equipment. They sent a Purchase order to the provider asking to use the insurance first. Here is the question... Our insurance only pays every 3 years and we may need to keep that option for the purchase of a wheelchair. So how do you resolve this? Can you ask MDA to pay for this ignoring the insurance? Thanks in advance...

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There is a couple ways you can try to get around this. First is to make sure your insurance company denies your request. The other thing is you can ask your local MDA to waive the insurance denial. I called our insurance carrier and asked them to please deny the request when it showed up. I was in constant contact with our insurance provider and our MDA office for my sons scooter, honestly I had such a hard time getting ahold of a human with our insurance company that the MDA just paid for it with a verbal denial when all was said and done. I know of other MDA offices not requiring the insurance denial prior to paying for the equipment. Just call your insurance company and see if you can get a denial for the equipment, they may just be willing to do a prior authorization denial, the way to do that is to ask for it and not send in the required documentation needed, such as the MD order then they would have to deny due to lack of documentation. The MDA rules do not state why the insurance denies it, only a denial. (I am an appeals nurse for a insurance company, we have to deny for lack of documentation for alot of DME if no MD order is supplied). Some companies require no precertification and then it's a bit harder in that you only send the claim
Last fall I wanted MDA to pay for a scooter for my son. My insurance wouldn't pay anyway because I have an individual insurance plan and can't get coverage for Durable Medical Equipment (DME.) However, they could have tried to bill medicaid which would have messed things up when we need our first wheelchair. I asked our local MDA rep. during a routine clinic appt.. She didn't think it would be a problem for MDA to pay for the scooter. However, when the vendor tried to collect, the MDA told them the same thing - bill insurance & medicaid first. That's the standard operating procedure. In my case, when the vendor got back with me and relayed the situation, I told them to NOT BILL MEDICAID under any circumstances. They went back to my local MDA rep. who had given the original okay and somehow resolved it amongst themselves. MDA is well aware of the 3-5 year waiting period (depending on your insurance.) I would contact your local MDA person and make your case. Many vendors are also used to working with the MDA and can work on your behalf. Good luck! Start with sugar and honey and get your MDA person on your side. I've also found that I need to always paint a picture with my request. For instance, I didn't just ask my MDA rep., I explained why I need it. For instance, when I go to the mall with my 4 children, I have difficulty pushing my 6 year old son with DMD and my 2 year old at the same time. My six year old doesn't fit in the double stroller anymore.
Thank You. I guess I will try calling MDA tomorrow. I am not sure what the response going to be, I hope I can buy the scooter before the start of school and sort these things prior to that...I should have started this process a month back!
Even if you order a scooter tomorrow it will usually take about 3 weeks minimum for most DME to come in unless you have a place that has scooters in stock, so know that it will take a bit of time for it to come in and some time for him to learn how to drive it.

Bains said:
Thank You. I guess I will try calling MDA tomorrow. I am not sure what the response going to be, I hope I can buy the scooter before the start of school and sort these things prior to that...I should have started this process a month back!
Can the $2000 be used for night splints also?
Jennifer
when we got our scooter, the mda told us the same thing. Our INS required a letter of neccesity so I emailed dr wong for it and told her why. She was angry as this is not mda policy! She called her local mda and had them call my local mda. The scooter was ordered that day! Our local dme provider was shocked. Ask the mda to show
you in writing this policy. It is not there! Good luck!
OK, I called MDA today and they said they will take care of it. I did not even have to give any explanation!

Ofelia: Yes you can use that towards night splints also. Keep in mind that the MDA only pays every 5 years, I believe. So you need to figure out when would be a good time to use MDA.
Also keep in mind that many mda's only let you submit financial request 1 time, so lump your requests together!!
Yes Ofelia as far as I know but you have to really weigh out what your expenses are going to be for 5 years. Heather decided to pay for the night splints and use the money for a scooter instead. In your case you might have enough inbetween but since your guy is little and still growing I'm not sure how many pairs of splints he will be going thru?

Ofelia Marin said:
Can the $2000 be used for night splints also?
Right. Probably my insurance (Aetna HMO) pays most.

Thanks!

Jacobs Mommom said:
Yes Ofelia as far as I know but you have to really weigh out what your expenses are going to be for 5 years. Heather decided to pay for the night splints and use the money for a scooter instead. In your case you might have enough inbetween but since your guy is little and still growing I'm not sure how many pairs of splints he will be going thru?

Ofelia Marin said:
Can the $2000 be used for night splints also?
Isn't it every three years that MDA will help with an equipment purchase?

Ofelia,

Being that your son is so young I would suggest you use it for the first thing you need. We waited thinking that another more expensive purchase would come along that we would need to use it for. So he is now 15 and we just now used it to help with the purchase of his first power chair. I believe they paid the OT fees. We were always worried that we would use it for say night splints and then would need an expensive chair and not be able to use it. So in waiting we have only utilized it once when we could have used it at least a couple of other times.

Janine

Jacobs Mommom said:
Yes Ofelia as far as I know but you have to really weigh out what your expenses are going to be for 5 years. Heather decided to pay for the night splints and use the money for a scooter instead. In your case you might have enough inbetween but since your guy is little and still growing I'm not sure how many pairs of splints he will be going thru?

Ofelia Marin said:
Can the $2000 be used for night splints also?
I agree with Janine about using your MDA money early. We jumped the gun and bought our scooter a little early so we could start our 3 year cycle a.s.a.p.

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