Many types of patients benefit from loan program
They must go through screening first
Any disabled resident of Massachusetts is eligible for the Spaulding Rehabilitation Hospital-Fleet Financial Group assistive technology home program. Participants don't have to be patients at Spaulding, but they do have to go through a technology assessment at its Assistive Technology Center (ATEC).
Staff at ATEC recommend whatever devices the patient needs and give the patient a form to take to Fleet Bank for a loan. "We are here as skilled technicians to assess their needs, but we don't deal with finances. The bank does that," says Seymour Smith, vice president for development.
Following is a list of situations that cover the typical loans Fleet makes:
o Patients need equipment their insurers don't consider medically necessary. For instance, some private insurers won't cover bathroom equipment or modifications, and voice output systems are not reimbursable by private insurance or Medicare.
"High-tech equipment, such as environmental control units, is not considered medically necessary, but it makes the difference in a person being able to live independently and having to have 24-hour-a-day care," says Maryann Girardi, PT, ATP, of the ATEC staff.
o Patients' equipment needs exceed their insurer's reimbursement cap. Some HMOs and other insurers have caps on reimbursement for durable medical equipment as low as $1,500 a year. "When someone has a stroke or a spinal cord injury, that $1,500 goes real fast, and we haven't even talked about wheelchairs," Girardi says. Power chairs start at $3,000 and and go up to $30,000 with environmental control units included, she adds.
o Patients need a bridge loan to pay for equipment their insurer will eventually cover. In some cases, equipment may be covered, but it may take months for patients to get reimbursed. For instance, a lot of durable medical equipment vendors won't take Medicare assignments for power wheelchairs because it takes so long to be reimbursed. Only one vendor in Greater Boston will take Medicare assignments, Girardi says. Vendors will do the paperwork, but they have to be paid upfront.
o Patients need a bridge loan while they go through their insurance company's appeals process. Appeals for denial of reimbursement can take as long as two years. The low-interest loan enables patients to function independently while they await reimbursement.
o The company simply won't pay for something. Home modifications such as wheelchair ramps, stair lifts, and power lifts for vans are not covered by most insurance.
o Insurers will fund only the less-costly alternative when another piece of equipment would be best for the patient. "This loan enables people to get the best match in equipment when insurance won't pay for it," Girardi says.
Some patients simply will abandon their technology because what the insurer would pay for didn't meet their needs, she adds. "It's hard when you know that there is a piece of equipment that's better. It's easier to use and has fewer parts, but the patient can't get it because insurance won't pay."
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