Mobility providers stand ground on standers

Wednesday, July 24, 2013

NCART in June released a funding guide to help providers who are having a harder and harder time getting approved and paid for standing equipment.

The guide outlines how to do a comprehensive evaluation, how to document a person’s medical need, and what steps to take if a claim is denied.

“This equipment should be covered,” said Don Clayback, executive director of NCART. “If it does get denied, it helps if you’ve done all the steps and documented medical need.”

Medicare doesn’t cover staning devices, because it says the equipment offers no medical benefits; Medicaid programs generally pay for it only if it is for children, and sometimes not even then.

Now private insurances are following suit, providers say.

“More of the private insurances are starting to deny them,” says Thana France, an ATP at Orlando, Fla.-based Browning’s Health Care. “Funding is getting tight.”

Providers say several studies support the medical need for standing equipment, which can improve a user’s digestive health, bone strength and mental health. 

“It does a lot for the people to be able to interact face-to-face instead of sitting down,” said David Gurganus, an ATP with Hattiesburg, Miss.-based A&A Home Health Equipment. 

Two bills in Congress that would create a separate benefit for complex rehab may be the key to ensuring coverage for standing equipment, says France.

“If we can separate out specialized equipment, maybe more complex equipment will be covered,” she said.

In the meantime, for adults who need standing equipment,  it can come down to timing, say providers.

“A lot of these insurances won’t cover people over 21,” said Matthew Convery, an RTS with Alexandria, Va.-based Rehab Equipment Professionals. “If they’re 18 or 19, they’re probably not going to grow any more, so they can have the stander we provide then permanently—as long as they don’t break it.” HME