The Insurance Company Denied My Brain-Injured Son The Care He Needed Because Of “Convenience Items”

image from Karen Pyros-Szatkowski
image from Karen Pyros-Szatkowski

I’d like to meet you. I’d like to understand better. I’d like to know who you are.
 I’d like to know if you have legs that work, a body that responds, a fully functioning brain. I’d like to know if you think twice before standing up, before walking to the bathroom, before reaching up and opening the kitchen cabinet. I’d like to know if you go for a run after work, ride a bike, hike, or just stroll through the woods. I’d like to know if you know what it would be like if you couldn’t do any of those things. I’d like to know if you have ever remotely known anyone with a disability and if you have ever felt even one ounce of compassion.

I’d like to know if when you slammed the rubber stamp of total denial down on our request for the power chair that offers the option of standing and seat elevation for my son, providing so many degrees of independence, you thought outside the box at all. I’d like to know if you even tried to come up with a solution or a compromise that would be in the best interest not only of your company but my boy, as well.

Your words: “Denied completely because based on the medical director’s scientific and/or clinical judgment, the documentation shows this service, group 4 power wheelchair and accessories, is not medically necessary. The power standing feature and power seat elevator are noncovered because they are not primarily medical in nature. THESE ARE CONSIDERED CONVENIENCE ITEMS. Therefore, this request is denied.”

I’d like to know why standing and reaching and living more normally are a convenience. I’d like to know why weight bearing on those legs, independently, without needing the help of an outside person, helping them to regain function, is not at all medical. I’d like to know if you think using your legs is just a convenience. Do you think that wanting a multifunctional higher end chair is the same as wanting a high-end sports car? Do you think we are greedy in asking?

I understand that the chair costs as much as a new car. And we are more than willing to fund as much as we have to. I just don’t understand though, if you are willing to pay for any type of wheelchair at all, why those funds cannot be used towards the purchase of this chair, with us making up the difference. I am not even asking you to spend a dime more than you would on the other type of chair. I’d like to know why when you saw the chair model you immediately denied it and will not compromise. Why not price the lower end model and offer us that amount toward the chair? I am naïve to your reasons. Please help me to understand.

Your use of the words, “convenience items” honestly makes me sick to my stomach. There are other words….there are other ways.

I’d like to know if you know that if we based our outlook on other doctors’ “scientific and/or clinical judgment” a couple of years ago, our son would not be here today?

No matter what we have to do, my son will get the chair that is best suited for him. We won’t compromise. I wish you did.

I have no respect for your “scientific and/or clinical judgment.”

Never mind. I don’t want to meet you. TC mark

This post originally appeared The Manifest Station.

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