Friday, June 10, 2011

Chillout Chair Victory!!

When Sadie was really little, we learned that the only way to calm her was to provide some serious vestibular input, she needed to MOVE! The bouncy chair worked perfectly for this, and we were not afraid to use it all day and take it with us everywhere we went. But then it broke. So, we replaced it. Then that one broke...and so did the next 3 after that. We finally decided that Sadie was too heavy for the bouncy chair, and we sadly had to give it up. That was a scary time for us, we didn't know how else to calm her down. We could bounce her on the yoga ball, but that was a lot of work, and you couldn't do much else while you were bouncing. We were afraid we were in for a lot of screaming, until one day Sadie and I went to PT and there was a chillout chair. It looked comfortable, and I'm always looking for something to sit Sadie in that will fully support her, so we tried it out. Then we learned that it rocks. A couple of weeks later we were bringing it home to try it out for a few weeks until we could get our own. (the one we have is like the picture, except instead of wheels, the bottom is rounded so you can rock rock rock) The problem was that they cost close to $1000. Welcome to the world of Special Needs, where everything cost so darn much because they know that insurance will pay for it!

The problem is that it takes a long time to go through the process of insurance approving it, ordering it, shipping it, etc. So, sometime in the middle of April we started that process. First, our Occupational Therapist had to write a letter to Dr. Wendy explaining why Sadie needed this chair and how she would benefit from it. Then Dr. Wendy had to write a prescription for this chair. Finally, it is submitted to our private insurance as well as Sadie state health plan for long term care. And somewhere in there, a company called Preferred Home Care got involved. They are like a broker between us and the insurance company. The insurance company won't deal with us directly, so they go through Preferred, who then takes care of the ordering and delivering of whatever item it is we're getting. Once all that was taken care of and we properly crossed our t's and dotted our i's, then we waited.

And waited.

And waited some more.

Finally we got a letter stating that the insurance company believed it to be in Sadie's best interest to take an extra two weeks to see if they couldn't find a cheaper alternative that would still meet Sadie's needs. In the letter there was a fax number where we could send additional information pertaining to the case. I was a little upset. I felt like if I could just bring them to my house for an hour, or send a video, they'd understand and be rushing to sign the approval...but that's not the way it works.

Instead, I typed up a letter clearly giving my reasons why Sadie needs this specific chair and no other one will work (we looked already for an alternative that we could purchase and not have to deal with the insurance company!). Then I sent a copy of that letter to Dr. Wendy and Jessice, the OT, and asked them to craft something similar to also send to the insurance company. I also called Jason at Preferred Home Care and explained to him the situation and he called the insurance company to explain further why this chair was required. He encouraged me to build a strong case, one they can't ignore, so I did.

And it worked, because I got the call last Friday from Jason telling me the Chillout Chair had been approved!!

One more victory for Sadie.

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