The Price of Independence

It’s been a long time since I’ve been able to get into and out of bed by myself.

In my March 18 blog post I wrote that I was trying to get my hands on a device that would dramatically improve the ease and safety of my home transfers, and possibly allow me to transfer independently. Good news – shit’s happening.

My amazing occupational therapist, Maren from Coastal Rehab in Cape Elizabeth, is working with me on this project. After we investigated the various overhead lift systems available in the marketplace, in the same way that six years ago I investigated the various wheelchairs available in the marketplace (and found the iBot), one particular technology stood out above the rest. The Sure Hands lift system has the unique characteristic of allowing a disabled person to control the entire process. If I had one of these, I could transfer from bed to Invacare wheelchair to shower chair to iBot wheelchair to toilet, or any combination thereof –all by myself. How cool would that be?

Below is a YouTube video showing how the system works. If you’re reading this post through an email, then click here to watch the video.

I learned that my good friend Darcy, who has MS and lives in a condo just down the street from me, already owns a Sure Hands lift system. I gave it a trial run. The first thing I noticed was how tightly the Sure Hands grabbed me around my upper torso, just under my arm pits. It was uncomfortable. But I decided that the vice-like grip of the Sure Hands would be something I could live with in order to take advantage of its significant benefits.

The Sure Hands system is distributed in Maine by All-Ways Accessible, out of Concord, New Hampshire. I contacted them and asked for a quote. A few days later Heather showed up at my door. She reviewed the system operation with me and looked over the job site, which included my bedroom and adjoining bathroom. She also spent time in the attic, assessing how the system would be supported in my ceiling. I asked her if we could adjust the lift mechanism so it didn’t squeeze my torso so tightly. She responded, “No. You don’t want it to drop you.”

Good point.

A few days later I received a quote for $12,000, plus or minus. Heather asked how I would pay for the system, and I indicated that I was looking into insurance coverage. She informed me that very few of her clients were successful in obtaining reimbursement from insurance companies, but she wished me luck.

To me, this should be a no-brainer for the insurance company, even if the decision is based solely on dollars and cents, with no consideration given to morals, ethics, or compassion. Installing one of these overhead lift systems would be a lot less expensive than any of a number of injuries my wife or I might suffer by executing all these transfers manually. But I don’t really understand how insurance companies make their decisions, so I didn’t find this logic particularly comforting.

I called Anthem and reviewed the situation with them. They indicated to me that if medical necessity could be established (piece of cake), this would be a covered expense. I was encouraged, but still skeptical.

Maren and my primary care physician’s office put together a package requesting preapproval from Anthem. After weeks of back and forth – questions asked, answered, and then asked again – I received a letter from Anthem. It read very much like a rejection, but was it? They disallowed my request on the grounds that I could obtain a similar system in-network, from a local vendor in Maine. Well, that simply isn’t true. But even then, I found a single paragraph on page 2 of the letter which said that I could choose to use the out-of-network benefits program to obtain the system from All-Ways Accessible.

I contacted Anthem to ask what the difference in cost would be for me between the out-of-network and the in-network programs. They explained that it is a maximum out-of-pocket expense of $2500 versus $800. Paying only $2500 for a $12,000 system doesn’t sound like a rejection to me. I went over the issue several times with the Anthem representative to make sure I understood it. I think I do.

Here is how I expect things to proceed. All-Ways Accessible will be here on May 15 to install the overhead lift system. I will pay for it using my credit card. I’ll file a claim with Anthem for $12,000, and they will reimburse me $9500. If things actually proceed in the manner I expect, I will be thrilled. Yet, part of me still worries….

My next post on this subject should be a series of photos of my new system, with gushing praise for how much it has improved my life, and all for a manageable amount of money.

We shall see.