Subject: Final Appeal Decision – Aetna
Aetna
4-30-08
Wheelman
Subject: Final Appeal Decision
Sear Mr. Wheelman:
This letter is in response to the appeal request we received on April 30, 2008. This appeal is regarding the denied predetermination request for the TiLite ZRa wheelchair and accessories supplied by Monroe Wheelchair.
A medical director, board certified in internal medicine and geriatrics, who was not involved in the original decision, participated in the review of this appeal. We reviewed all available information including:
* your correspondence,
* clinical documentation submitted,
* and Aetna Clinical Policy Bulletin Number 271.
Our Decision
Based on our review of the above information, we are reversing our previous benefit decision and will now allow benefits for this TiLite wheelchair and accessories.
Upon review of the submitted clinical documentation and the related clinical policy bulletin on wheelchairs, the prior determination is overturned. Coverage will be allowed for the requested ultra light wheelchair, special wheels/tires, and other accessories. With the diagnosis of sacroiliac dysfunction and your unique clinical situation, this wheelchair appears to provide the most benefit to support activities of daily living with the least amount of discomfort and with improved mobility.
>>My original goal was to acquire myself independence inside my home. I did not expect to also find the system as broken as I did…
[...] unknown wrote an interesting post today onHere’s a quick excerpt Aetna 4-30-08 Wheelman Subject: Final Appeal Decision Sear Mr. Wheelman: This letter is in response to the appeal request we received on April 30, 2008. This appeal is regarding the denied predetermination request for the TiLite ZRa wheelchair and accessories supplied by Monroe Wheelchair. A medical director, board certified in internal medicine and geriatrics, who was not involved in the original decision, participated in the review of this appeal. We reviewed all available information [...]
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May 6, 2008 at 11:04 am
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Medicine » Blog Archive » Subject: Final Appeal Decision - Aetna
May 6, 2008 at 2:28 pm
I am representing a family whose daughter’s spinal cord was severed at T5 due to an intoxicated driver. AETNA just denied their request for a TiLite Aero Z manual wheelchair and I need your assistance in understanding what information you submitted to have them reverse that decision so that I can help my 16 year old client. I fight insurance companies all the time, but to deny this simple request is unbelievable. Please either email me at idelariva@dk-atty.com, or call me at 210-224-2200. I would sincerely appreciate any assistance you can provide.
Thank you.
Isabel de la Riva
Attorney at Law
idelariva
August 8, 2008 at 2:44 am