The information in this blog post is for educational purposes only and is not intended to be billing or legal advice. The information provided does not guarantee funding from any source. For coverage information, verify the policy of the appropriate provider.
This information is specific to the United States.
Understanding how to navigate funding for Complex Rehab Technology (CRT) doesn’t have to be “complex”, but it can be a little overwhelming if you are not familiar with the funding process. You will have a team of CRT specialist that can help you obtain your appropriate equipment. Your team includes YOU, your physician, therapists, and an Assistive Technology Professional (ATP). Each team member plays a role in advocating for you by explaining to your insurance why you need the specialized equipment that they are recommending for you.
How do I find out what is covered by my insurance policy?
Depending on which insurance carrier you have, there are several ways to determine what benefits are available. You can always call the insurance company directly and ask them what benefits are available for durable medical equipment (DME) and specifically complex rehab technology (CRT) equipment. If you have an employer sponsored insurance plan, your human resources office should be able to provide this information to you as well.
What if my insurance denies the claim for my equipment?
A denial does not necessarily mean you will not get your equipment, but it does add time to the process. There are several levels of appeal available that allow for further information to be provided to the insurance company for reconsideration. Your provider and clinical team can assist with this process. If you need assistance for an appeal or a denial, please feel free to email US_Funding@permobil.com
How often can I get new equipment?
The general rule of thumb for complex rehab equipment replacement is five years unless you have a change in your medical condition and require new equipment to meet your needs. During this 5-year period, your insurance company will pay for reasonable and necessary repairs to keep your equipment functioning properly.
What is least costly alternative and how does it affect you?
Least costly alternative is a term used by insurance companies to ensure they meet your medical needs for the least possible cost to them. In theory this seems reasonable, however, complex rehab equipment users often have advanced needs that cannot be adequately accommodated with less expensive products. This is important to know because whatever equipment you end up with will have to last five years, and less expensive does not always equate to the most appropriate outcomes for you.
Not every insurance will fund everything your CRT team recommends for you, but that doesn’t mean they shouldn’t try! Sometimes they will need to work a little harder to get items covered. If you continue to have funding issues for equipment that is recommended you can explore alternative funding. Permobil’s clinical and funding team is always here to help you and we can be reached at US_Funding @permobil.com.
Permobil Clinical Education Team
This information comes from the Permobil Clinical Education team which consists of a group of Occupational and Physical Therapists. Click here to learn more about Permobil clinical education team.