Even at four, Gabriella hadn’t outgrown her baby carrier. She grew in sporadic bursts, but like most things, her weight remained behind the norm. So did her length, a word that bothered me because she was at an age where parents described their children as forty inches tall. But because she was unable to stand, they measured her lying down and reported her height in length.
Not long after starting at Lakeview School, Lisa brought her to their well-respected wheelchair clinic. This, too, was a reality I had come to gradually. Because our daughter had an angelic face, it wasn’t always obvious in public that she was too old to be sitting in a stroller, at least until she contorted and whined. We absorbed that we would need to move to something more grown up, but the idea of our child in a wheelchair seemed so final.
The director of the wheelchair clinic did a thorough evaluation and confirmed our fears. Gabriella couldn’t sit independently and she lacked the necessary support. As a result, she wasn’t eating well and her posture was worsening. She needed a platform that made it easier for her to swallow and improved her digestion.
They introduced us to the Panda mobility buggy. I had never imagined such a thing existed, a whole system of devices. While out and at school, her buggy would sit on a wheeled base. The buggy and base were detachable, allowing me to stow both pieces in the trunk of our Camry when we took her out. The Panda came with a separate component to snap the buggy into at home. Lakeview’s recommendation also included a solid seat and back customized to fit Gabriella, and a variety of other parts, including supports for her torso and legs and feet. There was even a sun visor because her eyes were photosensitive following her cataract and strabismus surgeries.
My sorrow at the thought of my child forever in a wheelchair turned to hope. This system would help her eat better and would correct her worsening posture. Months of work culminated when Gabriella’s pediatrician wrote the prescription and we submitted to the insurance company.
It took them only two weeks to mail us their denial “because custom chairs and equipment are not a covered benefit”. We were disillusioned.
This equipment had piqued my optimism. If necessary, I told Lisa, we would pay for it ourselves, even though it cost more than $5,000. I was prepared to cut corners to give her the solution she needed.
Then we heard that many insurance companies deny expensive equipment in every case. They knew some families would pony up the cost themselves, while others would give up. Not long before, I had moved to work for an organization well known for ethical behavior. In comparison, this unfeeling approach seemed wrong.
We decided to dispute the rejection.
As always, we were thorough in our appeal. And as usual, Lisa did most of the work. Over time, we encountered these rejections for everything we sought for our daughter’s care, but this was a new experience. We rebuilt a case we thought we had detailed in our original submission.
And then we waited.
In mid-December, six months after their denial, we received a response from our insurance company. The letter started by telling us they upheld their rejection of the sun visor and the basket, calling them convenience items, and not covered benefits. I never knew why they felt the need to make this point first – perhaps to save face? They went on to say they had reversed their decision and authorized coverage for the Panda mobility chair, home underframe, shoe holders, seat insert with lateral trunk supports, tray, headrest, anterior chest support and the labor to install.
It was an early Christmas present from an unlikely Scrooge.
Soon after the New Year, Gabriella was getting around in her purple Panda. She ate better. Her posture still wasn’t great, but she gained reinforced support.
And we learned a valuable lesson that would benefit us in the years to come, and that we would pass on to others: when the insurance company denies your submission, No doesn’t always mean No.
