Elijah James and his service dog Tobias are back to school
As a person growing old with disability, I’ve had decades to get acquainted with the ins and outs of the systems of goods and services available to people who live with challenges, particularly those associated with mobility and ambulation.
In Canada, medically necessary is a term ascribed to health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.
In the insurance industry, medically necessary relates also to the coverage available for acquisition of therapeutic aids and devices such as wheelchairs and scooters, among other aids to daily living and/or wellness/care management.
Broadly, health insurance companies provide coverage only for health-related services defined or determined to be medically necessary. Medical necessity refers to a decision by your health plan that your treatment, test, or procedure is necessary for your health or to treat a diagnosed medical problem. From time to time a patient’s case may be reviewed to determine efficacy of continuing with a particular course of treatment, therapy or use of certain devices and aids.
My head goes into spin mode when when I look to how the insurance industry specifically needs to examine what the ever-elusive ‘they’ view as medically necessary. To my way of thinking, particularly with regard to children and therapeutic aids like power wheelchairs and mobility scooters, they become ‘medically necessary’ when by virtue of their use, they improve physical health because they’ve contributed to improving emotional wellness/health.
The industry could actually save considerable money in the long-term if they allowed for the one-off of a scooter or a wheelchair that didn’t have restrictions such as ‘must be suitable for both inside and outside use’. Unfortunately, many people, both young and old, who would physically benefit from a scooter or power chair are turned down, denied, because the ‘intended use’ doesn’t fit the ‘little blue book’ of rules and regulations set out by the industry. Children with since birth disability don’t have faces; they have numbers. Therein lies the flaw in the system of service delivery.
I know my quality of life, as a child growing up with cerebral palsy, would have been significantly enhanced if I had a wheelchair to use for part of my day. It would have allowed me to be more able to interact outside and feel included; walking with heavy metal braces was exhausting. I suspect it never occurred to my parents to incorporate part-time wheelchair use into my formative years. I consider the era — pre-mainstream inclusion.
At university, in the 1970s, a scooter would have been perfect for getting around on campus, not only to classes but also for social outings ‘down the hill’ at UNB. Back then, I didn’t venture very far on my sticks. Winter months posed restrictions to crutches users that wouldn’t have been such an issue had a mobility scooter been available. It’s important for young people with mobility disorders, as they grow, to experience life beyond their disability and therapies. The insurance industry, in acquainting themselves with the emotional cost of living with disability, would then have opportunity to significantly change the game by lifting all restrictions to approving mobility scooters. Parents of children with deficits to mobility shouldn’t have to jump through hoops to provide their child with opportunities outside the home and classroom. Life’s unfair enough as it is without entities like the health insurance industry, with powers to make change, continuing to be unyielding with the ‘denied’ stamp.
My young Facebook friend, Elijah James, and his Mom, from Tennessee, have a public awareness Facebook presence — that’s how I got to learn about him. He was a ‘denied’ victim. Eli lives with a rare form of Spina Bifida called Rachischisis. It is usually 100% fatal. Eli has exceeded expectations, and undertook wheelchair training at the Patricia Neal Rehabilitation Center. When it came time for acquiring a chair, the insurance company denied it, saying he was too young and too small for a wheelchair. Hmm! The chair he trained in cost in the vicinity of $50,000!
I asked if I could help them reach their goal of getting this little boy’s life changer - his freedom. I approached the manufacturer directly and they agreed to slash $15,000 off the price; through fund raisers, the family secured the balance. Eli now has the ability to explore his world which is what little children need to do. On Facebook, the many photos of him engaged in all manner of fun things, along with his service dog, Tobias, are testament to the reality that a wheelchair or a scooter is not just a means to get from A to B. It’s life on wheels.
Physical engagement enhances emotional wellness which concurrently has potential to reduce burden on health care systems and systems of goods and services delivery like the insurance industry. A win-win! So, scooters and wheelchairs are physically, emotionally and mentally necessary to enhance quality of life.
Carla MacInnis Rockwell is a freelance writer and disability rights advocate living outside Fredericton, NB with her geriatric Australian silky terrier and a rambunctious Maltese. She can be reached via email at carmacrockwell@xplornet.ca
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