Those with serious disabilities often face bureaucratic struggles with their insurance companies, when applying for benefits, and when seeking out assistance from both government and private organizations. In another case that lead to frustration and complications for one family, a boy with cerebral palsy who could not walk or sit up on his own was told that he does not need a wheelchair.
Applying for Social Security disability for children and other forms of government assistance can be complicated. Similarly, filing a claim for insurance company can involve significant documentation and proof of illness, injury, or disability. A 2-year-old boy in New Jersey afflicted with cerebral palsy is unable to walk or even sit up without support, however, according to computer systems at Anthem Blue Cross Blue Shield, he should be given a cane before the insurance company agreed to provide financial assistance for a wheelchair.
The parents of the toddler have had to carry him around the house, to the car and hold him when they are out in public. When the boy grew heavier than 30 pounds, his doctors prescribed a specialized wheelchair with the expense of around $5,000. With their insurance plan, they pursued a claim and expected that the chair would be covered, but were promptly denied financial assistance by Anthem.
According to Anthem, the wheelchair is considered "medically unnecessary" for the boy. The insurance company stated that they need more proof that the boy could not get by with a cane or walker, even though he is unable to sit up on his own. Even the parents' attempts to explain the severity of the condition to the insurance company did not help. The family reached out to the media and was contacted by a reporter. Apparently, once Anthem was contacted by the media, they changed their minds and approved the wheelchair.
If you have a disabled loved one or you are seeking out financial assistance because of an illness, injury or disability, it is important to consult with experienced advocates who can help protect your rights and ensure that you can collect the benefits you need and deserve.
Source: The Consumerist, "Anthem BCBS Decides Boy Who Can't Sit Up On His Own Doesn't Need A Wheelchair," Chris Morran, June 13, 2012.