Tuesday, March 29, 2011

Will my insurance pay for a new Tempur-Pedic?

An EDS friend of mine, Ila, were talking a couple weeks ago and I told her I was looking to get a new bed, she mentioned that our insurance companies should pay for a therapeutic bed for us as it would be considered durable medical equipment.

I then decided to look into this since I had already laid on all types of beds and fell in love with the Tempur-Pedic Allurabed. The bed however, is $4,500 and is kind of higher than my bed budget was going to allow. I had read on another EDS blog about Angel Beds which are supposed to be comparable to the Tempur-Pedic however you have to order it online and hope you like it. Those beds were half the cost but you can't lay on them first, and although they have a no risk guarantee (free shipping both ways) it still seemed like kind of a pain.

Anyway, I first called my insurance (Anthem BCBS) to even see if this was possible. The representative told me that they would pay 70% of the contracted cost (with Memorial) for it as long as I had

1. met my deductible for the year
2. had documentation proving the need for it (including a prescription & Certificate of Medical Necessity)
3. found a medical equipment company in network that would get it for me

Well #1 & #2 at this point were not a problem, #3 however was kind of tricky... I called up Memorial Home Care (who I happen to work for) and they told me they are unable to get Tempur-Pedic beds, and have tried to order them in the past however the company will not sell them to them.

(I should add in case you haven't figured it out that although Tempur-Pedic beds are sold in several stores in my area, since these stores that carry them don't take prescriptions, then I can't get it from them. That's why it has to come from a medical equipment company.)

The fact that Memorial could not buy Tempur-Pedic beds made little sense to me considering I had read somewhere that Tempur-Pedic had originally started by selling beds in the medical business for medical type reasons, and now I can't seem to get one for my medical reason?

Before calling other local medical equipment places on my local list in network with Anthem I decided to call Tempur-Pedic and see what was up and how I could get one of their beds.

The nice woman at Tempur-Pedic told me that the reason I can't get my bed from Memorial is because they do not sell directly to medical equipment companies. They stated they only sold to two companies, who then provide the bed to the medical equipment company. (I know, it sounds stupid.) The woman provided me with the names of two companies...

1. Biotech Medical 800-284-9857
2. Myers 330-963-6998

I decided to call Biotech Medical first because they were in Ohio, which is rather close to Indiana, they had a web site & it was the first company she gave me.

The lady named Kathy at Biotech Medical was awesome! Right away she said her company provides items such as the Tempur-Pedic beds to companies like Memorial Home Care so they can provide them to their clients. I gave her the contact info of the person I was working with at Memorial (who said he couldn't order the bed) and she said she'd call him.

Well, the next day I got a call from Memorial stating that they are now hooked up with Biotech Medical and are now able to order the bed. (Wow, that was easy, considering in the past Memorial couldn't figure out how to get these beds.) I was very excited!!

Hoping and assuming Dr. Lavallee would write a script for the bed I shot him an email asking for the script and told him how they wanted it written (specific model & size of bed). He then wrote it and I picked it up the next day.

A few days ago Memorial called and said that my insurance has approved this transaction and they will be placing an order for the bed soon. (This is totally awesome!)

Yesterday Dr. Lavallee's office called and said that I needed to take my prescription into Memorial (at first they told me to give it to the delivery man when the bed was delivered which I thought was weird) so I'm going to do that in a little bit. The lady from the Dr. office also said that the insurance company wanted more documentation about why I need the bed, or that kind of bed. She told me she sent over my files and that wasn't good enough for them. She said she wasn't surprised since I am recently diagnosed and although I've addressed many problems with Dr. Lavallee, I have only been seen for two of them (shoulder & foot pain) and they don't see how a $4.5k bed is necessary.

Any of you with EDS knows that some days are worse than others and there are times were certain body parts are really bad when the others are just kind of bad. We can't just go to the doctor and tell them "every single joint hurts" so we go for the worst things, and in my case, shoulder and foot. The insurance company does not realize that I have to make sure my knees are in place when I get out of my current bed or else I'll fall when I get up, or laying on my sides aggravates my bursitis, makes my shoulders separate, etc etc etc (I could go on and on). So anyway Dr. Lavallee now has to write some sort of letter or something to them explaining why I NEED this kind of bed...

...so that's where I am now.......stay tuned for part 2..........

5 comments:

  1. yay to you for being proactive and bringing this together. Boo to the medical supply company who could not take these simple steps when it is their business.
    And to the insurance companies, I ask again, why does some BS in accounting get too question a medical doctor's judgement? Oiy.

    Fingers crossed for you...

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  2. Thanks Nan :) I'll keep all of you updated on this...

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  3. I just asked my Dr. that same question today st my appointment. I have the same insurance as BC and would really love some more information. 100% serious. Wierd enough I also have the same initials BC. Please reply

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  4. Ben, I was not able to get them to cover my bed. I put forth a lot of effort including a letter from the doctor recommending it. I don't have the best Anthem insurance so maybe that's part of the reason? Maybe if your policy is better they will consider paying at least some of it?

    Also Ben if you'd like, join our local group on facebook (we have people from all over the country so location is irrelevant). My friend is a doctor who also has EDS and is in the group plus there are others you can talk to.

    It's called "Michiana EDNF (Ehlers Danlos Syndrome)" and here is a link http://www.facebook.com/groups/255210424505157/?fref=ts

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  5. This is a very informative blog for people in these situations. I appreciate you sharing your findings to help others with the process.
    Thanks much!

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