Medical Necessity
Medical Necessity refers to activities, which may be justified as reasonable, necessary and/or appropriate based on clinical standards of care.
For mobility, insurance providers must determine their customers have a medical necessity to provide coverage. With each payer comes a unique set of medical necessity/clinical coverage guidelines. Our staff references your health plan’s specific requirements to ensure your member’s mobility needs are met in a timely and efficient manner.
There is a lot to evaluate with complex wheelchairs. We’re here to help you assess each member’s claim.
Learn more about the benefits of our products and how they benefit your customers.
Adult Products & Services
Pediatric Products & Services
There is a multitude of areas within which to explore medical necessity. Our certified staff members are trained and experienced in determining which complex products best meet the medical needs of your members, and they work alongside the prescribing clinician to evaluate your members’ needs as they relate to:
Positioning:
- Allows gravity-assisted positioning against the contours and supports of the seating system
- Allows accurate positioning following transfer into the chair by adjustment of posture from the tilt position
- Best accommodates shear displacement (sliding out of position) during position changes
- Orthopedic/Neurological Considerations:
- Allows effective re-positioning during the course of the day
- Easiest accommodation of postural/orthopedic asymmetries and extremity contractures
- Promotes absent to minimal triggering of abnormal muscle tone or reflex responses during position change
- Can minimize some reflexive responses associated with position of the head (ATNR, STNR, TLRs) through the increased head control of postural stability
- Muscle tone management
- Positioning for relaxation of high muscle tone
- Positioning to reduce the fatigue associated with high muscle tone
- Positioning to inhibit some high muscle tone through increased postural support
- Positioning for stability/support with low muscle tone
Endurance:
- Can help increase energy
- Can increase sitting tolerance during the course of the day
- Positioning for comfort
- Positioning for pain relief
Function:
- Provides postural/proximal stability, required for function
- Can increase U.E. function through proximal stability
- Can increase head control through improved postural support
- Positioning to improve vision (“line of sight”)
- Can enhance postural balance when traversing challenging terrain
- Anterior tilt can make transfers into the chair easier and, in some cases, possible
- Positioning for safer/easier swallowing due to relaxed muscle tone in the neck region
- Positioning for feeding
Medical:
- Initial management of hypertensive episodes (A.D.) by immediately sitting the user upright
- L.E. Edema management (if used with elevating leg rests)
- Management of pain & discomfort associated with edema
- Can reduce respiratory difficulty through decreasing pressure on the diaphragm while facilitating an extension of the spine/trunk
- Allows use with ventilators
Caregiver Issues:
- Reduces attendant care required (through easier management of weight shift/pressure relief with less transfers in and out of the chair and overall increased sitting tolerance)
- Allows easier positioning for respiratory care for some
- Allows easier positioning for bowel/bladder management for some
- Allows positioning for toileting hygiene for some