So…your physician has given you the okay for you to start a standing program. Now it is time for you to gather your “team” who will help you determine what standing device fits your needs and work through the justification process with your payer. Your team should consist of one or more clinicians, a durable medical equipment supplier, and you, the consumer or caregiver. Each of these AT team roles is important.
The Consumer, Caregiver or Family- The leaders in the team process
The consumer or their legal guardian is truly the leader of the team process. As the leader, they need to follow up on progress of the funding process through its conclusion. They can specify who they want as their supplier, and their wants and needs in standing equipment. It is their responsibility to research the benefits of standing, and be present for the product trial and final fitting of the stander. Most importantly, then need to follow through on the standing program. The consumer or caregiver is the only one who can start the insurance appeals process.
The Clinician(s)- Assesses your needs and provides justification to payer
The clinician (typically PT or OT, but can be any clinician with emphasis on Assistive Technology) provides recommendations for standing devices, options, and standing programs. They also document justification for the payer sources and assist in the appeals process.
How to find one: Before you leave the physician’s office, ask if they can make a referral to an outpatient rehab facility or local clinician (Occupational or Physical Therapist) so that they can provide the standing frame assessment.
The DME Supplier – Where the stander is purchased from
The DME or Complex Rehab Supplier should have some product expertise and be able to line up a trial of the standing frame. When needed, the supplier will submit for prior authorization with your payer, review the clinician’s letter of medical necessity, and assist the clinician through the appeals process. Most suppliers will provide assembly, delivery, and fitting of the product.
How to find one: If you are happy with their service, contact the supplier you purchased your wheelchair from. You can also use the EasyStand Supplier Locator or www.nrrts.org to find a reputable supplier.
Where do you fit in on your team? Are you fulfilling your role? Do you think the team approach provides a good foundation for the process of purchasing a standing frame or other assistive technology?
Graphic courtesy of http://thegoldguys.blogspot.com/
Great posting Nancy. Perhaps there is an additional discussion to be had. With the correct stander on board, what activities can be done to increase usage? There is a brief discussion on use of a stander while playing video games. For your consideration: http://www.games4rehab.com/BDBlueMarble/videos/89