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Clinicians!
Try this new tool for creating your client's Letters of Necessity! |
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 If your request for a SleepSafe bed has been denied, you may have the right to appeal, but you must act quickly and follow every rule associated with the denial. Read the letter or correspondence very carefully to make sure you don’t miss a deadline. There is usually a short time line to complete all steps in opening an appeal, often only 15 to 30 days.
If you seek the help of your provider, you will need to sign a HIPPA release so they can talk to others on your behalf. Help them to help you! Do your best to provide the advocate or provider or anyone else whom you will seek help and advice with a complete packet of information that should include, at a minimum, the following information:
- Client Information (Person who has been denied)
- Salesperson and manufacturer representative information (SleepSafe Beds, LLC)
- The notice of determination (Letter or other communication stating claim has been denied)
- Letters of medical necessity (Any letters that were submitted with the claim; see samples below)
- Cost analysis information (LCEEA)(Provide information that you have considered and exhausted ALL alternatives and why a SleepSafe bed is the lowest cost alternative to fit your specific need)
- Product information (Be sure to provide the exact bed you need. There is a difference between a SleepSafe (low), SleepSafe 2 (medium) and SleepSafer (high) as are the differences between a fixed/manual, semi-electric and full electric. Provide a web link to the bed model you chose, a brochure, dimensions and specifications, etc…the advocate may never have even heard of a SleepSafe bed or any other specialty bed. It is VERY IMPORTANT for all of those involved to really know all there is to know about the bed you need).
a. This may include information on ‘specialty beds’ or ‘beds for those with special needs’, which could be different than a traditional hospital bed. SleepSafe Beds fit a very specific need…to prevent danger from becoming entrapped or injured within a bed, to help prevent rolling, falling or climbing out of bed and to provide a safe sleeping environment. This information may include any studies conducted on safety issues that may be associated with a traditional hospital bed or specialty bed or why some individuals may need a specialty bed. An example is the Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment published by the FDA. This explains the risk of entrapment in certain types of beds.
Remember: There is no guarantee that they will take your case, though they may hear the facts, review the information and investigate your case to at least discuss your legal options. The more prepared you or your vendor are when making that first call, the better your chance for success. Providing as much information as you possibly can upfront can help the advocate make a determination as to whether or not they will take the case and it can help them see that you are willing to go the distance to get this bed. It can be helpful to them to have so much of the information that will be needed in an appeal already gathered…reducing the amount of work it will take them; this could help them say YES!
Complex Child E-Magazine
Complex Child E-Magazine is a monthly online magazine written by parents of children with special healthcare needs and disabilities. It is intended to provide medical information, along with personal experiences, in simple language that other parents can understand. The following articles offer advice on how to beat insurance company denials:
Help getting insurance to pay for adaptive, special needs bed:
http://www.articles.complexchild.com/jan2009/00095.html
Help on writing an appeal letter:
http://www.articles.complexchild.com/00012.html
Information about general insurance and Medicaid:
http://www.complexchild.com/insurance.html
Another Resource: The National Assistive Technology Advocacy Project (http://www.nls.org/natdisc.htm may also be able to offer assistance as well. The Project receives its funding through the National Institute on Disability and Rehabilitation Research, U.S. Department of Education. This project primarily directs its nationwide support services to the network of Protection and Advocacy (P&A) and Client Assistance Program attorneys and advocates who are working on AT advocacy issues. They will also provide support services to Legal Services and Legal Aid programs and to attorneys in the private bar if they are working on AT-related issues. |
(Most of the beds that are sold
are covered by insurance, both private and Medicaid).
Two basic requirements are necessary:
Examples of Letters of Medical Necessity
Example
#1
Example
#2
Example
#3
Example
#4
Example #5
Patient
Information Questionnaire
Example #1
In a letter of medical necessity,
it must be clear that a SleepSafe® bed addresses SPECIAL NEEDS.
The key is to emphasize the clinical needs of the patient. It
must be pointed out how his or her needs are not being met by
the bed they are currently using. Once the failings or dangers
of the current bed have been detailed, a SleepSafe® Bed product
can be prescribed in answer to the particular needs. We also believe
it is important not to lead with a mention of a SleepSafe® product,
but rather wait until the 4th phase in the outline below.
1. Introduce the patient and how
long she or he has been in the care of the doctor or facility.
Describe his or her condition and detail the special needs that
are a consequence of the condition (i.e. lack of control; no recognition
of danger in rolling or falling out of bed; entanglement in side
rails if a "hospital/institutional" bed is currently
in use and the potential or documented injury as a result; potential
of entrapment or suffocation due to the gaps around the mattress
on either side or at the ends—especially the corners.)
2. Explain how the bed or crib
currently being used fails to protect the patient and the consequence
of falling will result in bodily harm. Include, if applicable,
how the patient has the capacity to climb.
3. Perhaps address the psychological
issues regarding the importance to see out and be seen/acknowledged,
and/or not be trapped in a bed with an enclosure over the top.
4. Recommend the bed model that
addresses each of the concerns — with specific requirements
such as full safety rails, or specific height required for safety
(where the double safety rail and mattress height adjustability
of the SleepSafer model would accommodate the needs), or the necessity
of articulation to raise the head or feet of the patient in order
to feed, medicate, or provide mobility.
5. The imperative that the specific
needs be addressed and prescribe the appropriate model (SleepSafe®,
SleepSafe Plus, SleepSafe® HiLo, SleepSafe® 2, SleepSafe®
2 Plus, SleepSafe® 2 Hi Lo, SleepSafer®, SleepSafer®
Plus, or SleepSafer® Hi Lo).
We appreciate the opportunity
to work with you and help find a way to work through the process.
Please feel free to call us if we can be of further assistance,
toll-free, at 866-852-2337 from 8 am to 5 pm EST.
*Visit the web to view “Hospital
Bed System Dimensional & Assessment Guidance to Reduce Entrapment
- Guidance for Industry and FDA Staff” (published 3/06)
"Safe
in Bed" Government agencies have long warned of the hazards
of bed rails, but they are still used in many nursing homes. (New
York Times article)
**SleepSafe® Beds patented
design exceed these new safety guidelines, virtually eliminating
entrapment issues**
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