What’s Happening to Durable Medical Equipment Coverage?

By Kim Cantrell, CFILC’s Director of Programs

Over the past several years private health insurance companies have slowly and steadily reduced durable medical equipment (DME) coverage. If you belong to a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO) and are not enrolled in Medi-Cal or Medicare, then your DME coverage limits may have taken a nosedive in recent years.

If you don’t need DME, then chances are you haven’t noticed the reduction or realized its consequence. For people who rely on DME, you are probably very aware of the coverage changes because it means that out-of-pocket costs have skyrocketed.

Years ago if you had private health insurance and needed a wheelchair, your health insurance company would cover a percentage of the cost of a new chair, usually between 70-90%. If you needed to purchase a $10k wheelchair, you would pay between $1-3k and the insurance company would cover the rest. The out-of-pocket amounts were still large, and it created a real burden on many families.

Within the last ten years DME coverage has become even more restrictive. Many companies are covering 50-80% of DME cost, but only up to an annual maximum amount, typically $2,000. This means that your out-of-pocket expense for that same $10k wheelchair would be over $8k, which is a lot more than $3k.

These coverage changes affect how often people can afford to purchase DME. People are still purchasing shower chairs, bedside commodes, and other low-cost items that fall within coverage limits, but the high-cost items are frequently out of reach. People are going without manual and power wheelchairs and other high-cost DME items. And when they do, they lose the independence their DME would have given them.  

The AT Network receives many calls from people who have private health insurance and still cannot afford to buy DME. They simply cannot afford the expense. Even though they have health insurance, it is not enough to cover what they need, and they call us looking for low-cost alternatives.

We live in a world of rising health care costs. Advancements in medical technology are expensive. I understand that health insurance companies are trying to control costs where they can, especially in places where many people will not notice. However, reducing DME coverage by imposing annual caps hurts people who already bear a large financial burden for their health care.

If you have private health insurance, do you have an annual cap on DME coverage? What kind of out-of-pocket costs are you paying?  

Can your organization apply for the AT Reuse & Repair Fund?

By Shannon Coe, CFILC’s Reuse & Finance Coordinator

Does your organization receive donated assistive technology devices?  And do the devices only need simple repairs such as new batteries, footrests, wires, tires, etc. to get them working again?  But your organization does not have enough funding to repair the devices.  You wish there was some money out there that could help repair all the broken devices in your AT storage room so you can give them to new individuals who need them.  If these thoughts have crossed your mind, then the Repair and Reuse Fund may be of interest to your organization.

The Repair and Reuse Fund gives organizations money to fix up second-hand AT devices for new consumers.  It is important to note that the fund cannot be used to pay for repairs on devices that already have owners.  For instance, I received an application from an organization requesting funds to repair a scooter already owned by an individual.  Although I understand her dilemma, funds can only be applied towards devices that are going to be reassigned to another consumer.  Thus, the devices must have already been donated to the organization.  The goal of the Repair and Reuse Fund is to support and increase the reassignment of repair devices to new consumers.

Established nonprofit organizations that are members of the AT Network and accept donated AT devices in California can apply for up to $1000 for the Repair and Reuse fund once a week.  Currently, a few organizations have applied for the Repair Fund, and some of them have submitted an application more than once.  As of April we still have over $16,000 left in the fund to be used until it gets exhausted or until June 30^th, 2011.  Many of the repaired devices have been power wheelchairs and scooters.  However, we would like to encourage organizations to apply for funding to repair other durable medical equipment and communication devices.

The application process is easy to complete.  In addition to submitting an application, a photo of the device and a 501(c)(3) letter can be e-mailed to shannoncoe@cfilc.org.  Once the application has been reviewed, the organization will be contacted as to whether their application has been approved for funding.  Upon approval, the organization can proceed to make repairs.  When repairs have been completed, invoices and receipts will need to be submitted in order to get reimbursed for the purchased parts, repairs, and labor. The reimbursement process thus far has taken less than 30 days to process.  Our goal is to get the funding out before the end of June 2011.

Click here to find out more details about the Repair and Reuse Fund. The information online will list the eligible activities and uses, funding criteria, and timeline.  Don’t miss out this great funding opportunity!

What devices do you have in storage that needs repairing?

My CSUN Conference Adventure

By Shannon Ramsay, CFILC’s Information & Assistance Advocate

I traveled to San Diego to attend the annual CSUN Technology and Persons with Disabilities conference last month.  Until this year, I have heard a lot about it, but I never had the chance to attend. 

I spent part of Wednesday afternoon and most of Thursday and Friday staffing the AT Network’s table in the exhibit hall at the CSUN conference.  We were located in the second floor ballroom along with all the other nonprofits and government agencies. 

I was able to take some time to circulate and visit with vendors in both parts of the exhibit hall on Thursday and Friday, and I have to say that I was impressed by how many organizations were present from foreign countries.  There were organizations at the conference from Switzerland, Germany, China, Canada, Ireland and Brazil.  It was especially informative to talk to individuals from these organizations to find out what sorts of services are available to people with disabilities in other countries.

I met with representatives from a British company called Traveleyes.  This company organizes trips all over the world for blind and sighted travelers.  The company helps blind individuals find sighted travel companions in the groups in which they travel so that the visually impaired travelers can fully experience the travel destination.  I checked out the Traveleyes website after I returned from the conference to see what sorts of trips the company has planned, and I found myself fantasizing about my next vacation.

This conference really allowed me to broaden my horizons about what types of technology are available for people with other disabilities including people with hearing and speech disabilities as well as various learning disabilities.  I was able to speak with representatives from a company called Interpretype which sells products to help people who are deaf or hard of hearing as well as individuals with communication disabilities.  This company sells products which help individuals who are deaf or hard of hearing communicate by way of text messaging and video phones.  Interpretype also operates a relay communication service and provides access to a remote interpreting service through its products.  

In addition, I found out about a company called Texthelp Systems, which provides a number of different software solutions for people with learning disabilities, low vision and print-related disabilities. This company provides literacy software solutions to help those individuals who have difficulty with reading and writing.  

I did have some personal interests to pursue while I was at the conference.  As a blind individual I am always looking for new solutions to the challenge of navigating unfamiliar environments.  It would be practically impossible for me to get advanced mobility instruction for every new location I have to travel to, so I am very interested in learning about alternatives such as GPS navigation, auditory directions, and tactile maps.  I was very impressed with the work that the company Click and Go Wayfinding Maps is doing for visually impaired travelers.  I was able to listen to a sample narrative map which this company has created at the CSUN conference.  Basically the narrative map provides the traveler with step-by-step instructions for how to get from a particular starting point to the traveler’s destination.  The maps are set up in a similar fashion as instructions from an orientation and mobility instructor who is teaching a student a new route.  I just hope that Click and Go Maps will start creating narrative maps for the Sacramento region very soon, which is where I live, work, and travel.

Finally, I used some of my time during the CSUN conference as an opportunity to conduct some research of my own into what solutions are available for portable scanning systems.  I wanted to check out these devices since I am in the market for something which I can use to scan and read printed text wherever I go.  At the conference, I was able to check out the Pearl scanner, a camera-like device which works in conjunction with a laptop and Open Book scanning software, and the Sarah scanner, which is a stand-alone reading machine.  Both of these scanning devices are sold by Freedom Scientific. Also, I tried the scanning system from Humanware that is manufactured by Intel.  I also stopped by the Sendero Group booth and got more information about the KNFB Reader Mobile I had the opportunity to speak with the different vendors and get hands-on experience with the various scanning devices at the conference. This helped me get a clearer idea of which device would best suit my personal needs.

I definitely had a very interesting experience at the CSUN conference, and I learned a great deal.  This conference is worth attending if you are interested in assistive technology.

Did you attend the CSUN conference this year? If so, please feel free to share what you learned in the space below.