It’s funny how you can say one thing and a few moments later have a chance to see how naïve you really are. Just today Dom and I were talking about the government. I said that despite all the bad choices that have been made and as bad as things are, we are lucky. We are incredibly lucky because we have a home, a car, and all of our basic necessities met. Deep down, I know that’s not entirely true depending on how you look at it.
Dominick is in a wheelchair. We live in our own home that I purchased prior to us moving in together. This home is anything but wheelchair accessible. Dom is able to get in bed via a Hoyer lift and when in his wheelchair he can get in one room (the one his Hoyer goes into to put him in his seat) and out the door. A ramp is attached to the house that we had to beg to get put on, due to the fact that we don’t live three minutes away where it would have been free. The ramp, which was put on three summers ago, is now rotting slowly due to poor workmanship and will likely need to be replaced (out of pocket, no doubt) this summer.
The funny thing is that until today it never dawned on me that something truly bad could happen to us. We had plans to move and while it is taking some time to pay off our bills we have kept positive by talking about the things we will look for in a new home to ensure that the home is right for all of us. We have fantasized about the new home we will have when we can save the money we make to get something we want to live in. Right now, those days seem further off than ever and one little letter changed my entire perspective.
A few months, back Dominick ordered a new wheelchair. It must have been at least six months ago, maybe a little longer. While Medicare had not approved it, there was little question as to whether they would or not because he had the old one for over five years and that is usually the minimum time needed until you purchase a new one. His old chair had never been right. He is 5’3” and they made it for someone over 6’. The leg rests were wrong, the seat was awful, and the seat back was even worse.
It wouldn’t even hold a charge. They tried to fix it, but there was no fixing it. He ended up lying in bed because the chair was so awful. Though he was very gracious about it and was just waiting for the day when he could get out of bed comfortably in a new chair, I know it had to be hard (and painful) on him.
When Dom got the new chair things began to look up. It was not exactly the chair that he wanted, but it was far superior to the one he had. However, right before Christmas, the official owner of the chair, Wheels in Motion, called to let us know that Medicare denied the claim. There was not much to worry about. They needed some more clarifications and information, and all would be well. He asked us to call MDA (Muscular Dystrophy Association) and let them know that he needed any files they might have. We were also to impress the urgency of the situation on them, letting them know that the wheelchair could be taken from us if this appeal does not go through.
Today we got the bad news. It did not go through. The independent review experts at RiverTrust Solutions have determined that Dominick does not need a wheelchair at all, or at least, not a new one. Considering he does not have his old one, it was taken when he got this one, if it were taken, and it very well could be, he would be left with nothing. There are many interesting points to this story and to the determination that RiverTrust decided to make.
The letter, which is attached to this post (CLICK ON THE IMAGE TO SEE THE ENLARGED VERSION), claims that “the power wheelchair and accessories (safety belt, batteries, skin protection wheelchair seat cushion, lateral trunk or hip support, and power tilt seating system) were denied because the documentation submitted does not establish the medical necessity.
In other words, they are blaming MDA stating that the facts that they collected during the examinations that Dominick had, were not good enough. The facts are that Dominick cannot walk and has not had a wheelchair suitable for his body in over five years. To someone that cannot walk, this practically ensures additional health problems and if they become bedridden (as he did) it means less physical movement by proxy and a load of other issues as a result. In short, a wheelchair is the closest thing to working legs a mobility impaired chair user has. Unfortunately, Kathy Warren and the folks at RiverTrust do not feel the same way.
RiverTrust appoints a doctor and a nurse to oversee the review. These people do not actually meet with the people involved in each case. No one ever spoke to or saw Dominick. No one ever called us. They looked at submitted documents and proceeded to play God based on whether they were having a good or bad day. At least that’s what I imagine based on this letter. Either that or MDA forged documentation to ruin Dominick’s life, which I find highly debatable.
According to the included letter the review panel looked at a number of documents including:
A Diagnosis Slip
A Physician’s Note
A Certificate of Medical Necessity
In addition to all of this, there was a Michigan Institute of Neurological Disorders visit note, which I am assuming is somehow MDA related. All of this information helped RiverTrust to determine that Dominick 
“meets the medical necessity for a power wheelchair.” That was the most accurate thing they said. However, after that, they listed a myriad of untrue reasons why they were not going to give him the wheelchair.
My personal favorite is:
“The documentation does not support the medical necessity for the power tilt seating system. The documentation shows that the beneficiary is able to weight shift and transfer from wheelchair to bed.”
I have been taking care of Dominick since we moved in together nearly 6 years ago. I use a Hoyer lift to transfer him. I have to bathe him. I have to feed him. If his leg is stuck, I am the one that moves it. I don’t care that I have to do these things because I love him and I want him to be as comfortable as possible. However, the thought of them taking away his wheelchair due to an independent company that has never even taken the time to make a phone call or meet the person they are dealing with is infuriating. I sincerely hope that Ms. Warren and the Doctors at RiverTrust never have to deal with such awful circumstances.
We can re-appeal, though at this point it does not look good. As this is Saturday we will have to wait until at least Monday to hear from the wheelchair company to determine whether they plan to pick it up, or eat the cost which is highly unlikely.I am not normally the type to ask for donations, but at this point I do not know what else to do. I can’t imagine what would happen if Dom lost his wheelchair. It costs nearly $20,000, which is money we simply cannot afford. I think the thought of him losing that part of his mobility scares me more than it does him, and I can imagine that it scares him pretty bad. I understand that not all people can or will leave a donation. For those of you that cannot do so, I implore you to write to your senators to try to change the Medicare laws. There are thousands of people with disabilities that are denied basic living aids every single day by Medicare.While I might go to sleep tonight hoping that I wake up tomorrow to a country that takes care of its citizens, I am smart enough to know that by morning nothing will have changed. You have the power to make it change though. All it takes is one letter at a time and the power of the unheard voices in America will get stronger and finally, one day something will be done.
Technorati Tags: Medicare, wheelchair, Dominick, legs, RiverTrust Solutions, Kathy Warren, disability, MDA, Medicare Denial
If you like this post, buy me a latté!
Last 5 posts by Ashtyn
ShareThis
Share and Enjoy:
These icons link to social bookmarking sites where readers can share and discover new web pages.
[...] also urge you to check out the picture I’ve posted of his rejection letter. Please consider helping Dominick. He doesn’t deserve this kind of treatment. No one [...]
[...] been under a remarkable amount of stress lately. You can read all about it here or here or here if you’re so inclined. Why I’m stressed really doesn’t matter as [...]
Update: Dominick was contacted yesterday by Senator Debbie Stabenow’s office. They will be sending a letter to Medicare on Dominick’s behalf, as they try to establish why he is being denied and what they can do to help him.
Please consider contacting Debbie and let her know how grateful you are that she’s looking into Dominick Evans’ wheelchair situation!
http://stabenow.senate.gov/