Hints on Insurance:
While each insurance provider may vary, in general two basic requirements are necessary:
1) Prescription from the
USER's doctor for the exact brand and model of
bed and medical features it needs. (it is the same idea as prescribing
medication)
2) Letter of Medical Necessity
and some insurance companies will prefer
appropriate supporting documentation.
In an increasing number of
cases, insurance companies will have a standard form for
“Medical Necessity” that must be filled out by the
physician ordering the bed. You will want to considering writing a
letter in addition to that document.
Overview
The key here is to remember this is medical necessity, not convenience. You must craft your document to communicate why the patient will either benefit from the bed, avoid injury, or suffer without it. We believe that only after those concepts are fully developed should you mention the solution, a BBG bed.
A Basic Outline for a Letter of Necessity
1. Introduction:
Introduce the patient including pertinent information such as age,
diagnosis, overall applicable symptoms, current care requirements, and
how long she or he has had this condition. You will have to gauge how
much information to share that will paint a good picture of the
condition and needs of the individual.
2. Establish the Need:
This may be anywhere from one to
three paragraphs and if you have more information,
consider adding attachments not just lengthening the letter.
Building off the introduction, tie the detailed clinical
description of the patient's condition / needs to the challenges
and risks in and around beds. For example, "low muscle tone
increases his risks of entrapment and resulting injury or death" .
In addition to the clinical description, you may want to elaborate on the physiological challenges that are created by their condition. Some examples include a history or propensity for: falling, climbing, seizure activity, lack of muscle tone and/or control, increased risks of entanglement with bolt on side rails or "hospital/institutional" bed rails, and entrapment or suffocation risks due to the gaps around the mattress found in most beds and some institutional beds -- especially for children.
We also believe in outlining the psychological benefits and risks that are addressed by the patient having (or not) safety and freedom as well as the ability to see out, to not be trapped or locked in, etc.
You will need to effectively communicate the dangers of either the current bed and/or dangers of standard bed choices, including inexpensive hospital beds. For example, many patients need to transition from a crib to a larger bed, and going to a normal bed won't be safe, or the patients condition is worsening and now needs additional assistance, etc. The dangers need to be broken down by how they fail to protect the patient due to their medical condition and the consequences that may result without a safety bed that addresses their specific needs.
3. Recommendation / Request: This section should be a conclusion to your arguments stating that the specific product from Beds By George satisfies the needs. It is mandatory that you specifically summarize how BBG features address the dangers you highlighted. Your final closing should always be a restatement of your conclusion in the form of a specific product request, thanking the reader for his consideration.
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Disclaimer:
The information on this page is opinion. We in no way guarantee insurance coverage nor reimbursement for our products. The information here is for informational purposes only and may or may not assist you in securing funding for medical equipment. It is in no way implied that if you follow these steps or use these examples you will be granted funding. Insurance coverage, application, circumstance, and policies vary. Be advised every case, every agent, and every insurance company is different. We strongly recommend that you communicate with your provider(s) and research other sources for information as well.
