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    #16
    Originally posted by nayr View Post
    I was able to get my insurance (private insurance) to pay for my RT300 and my portion of the cost was only about $1200. Well, I suppose a more accurate statement is that RTI was able to get my insurance to pay for my RT300. I have private insurance and they denied coverage, so RTI filed an appeal for me. They denied again and I think then there was another appeal, which was denied. And finally there's a last-resort appeal after either 2 or 3 denials. This last resort appeal gets sent out for "independent review", where a separate company (not my insurance company) looks at the claim and decides if it's medically necessary or not. The bike was deemed medically necessary by the independent review, so my insurance ended up having to pay for it. RTI did all the work with the appeals. I did have to call to stay on top of things and make sure things were progressing in the claim/appeal process. I think it ended up taking over a year to get through the process/appeals and finally get the bike. Try to work with RTI to see what's possible, and don't give up on it. I love my RT300 and use it every day I can, which usually ends up being 4-5 times per week (sometimes it's hard to make time with a job/kids/house/etc).
    Great to hear, nayr! It would be interesting to know based on the specific information the independent review used in rendering their favorable decision.
    stephen@bike-on.com

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      #17
      Originally posted by nayr View Post
      I was able to get my insurance (private insurance) to pay for my RT300 and my portion of the cost was only about $1200. Well, I suppose a more accurate statement is that RTI was able to get my insurance to pay for my RT300. I have private insurance and they denied coverage, so RTI filed an appeal for me. They denied again and I think then there was another appeal, which was denied. And finally there's a last-resort appeal after either 2 or 3 denials. This last resort appeal gets sent out for "independent review", where a separate company (not my insurance company) looks at the claim and decides if it's medically necessary or not. The bike was deemed medically necessary by the independent review, so my insurance ended up having to pay for it. RTI did all the work with the appeals. I did have to call to stay on top of things and make sure things were progressing in the claim/appeal process. I think it ended up taking over a year to get through the process/appeals and finally get the bike. Try to work with RTI to see what's possible, and don't give up on it. I love my RT300 and use it every day I can, which usually ends up being 4-5 times per week (sometimes it's hard to make time with a job/kids/house/etc).
      On my behalf, Restorative Therapies appealed the denial from my insurance company (Blue Cross Blue Shield of Michigan) to purchase the RT-300 for External Review by the State of Michigan Dept. of Insurance and Financial Services. Unfortunately, the denial was upheld.

      RTI's research indicated that BCBS Michigan had previously authorized the purchase of 8 RT-300 units. Somehow, though, my claim was denied. Naturally, I'm disappointed with the decision.

      The reviewer's rationale follows here:
      Recommended Decision:

      The MAXIMUS physician consultant determined that a RT300 FES Cycle Ergometry Rehabilitation Therapy System is not medically necessary for treatment of the member's condition.

      Rationale:

      The MAXIMUS independent physician consultant, who is familiar with the medical management of patients with the member's condition, has examined the medical record and the arguments presented by the parties.

      The results of the consultant's review indicate that this case involves a 54 year-old male who has a history of T4 paraplegia secondary to arteriovenous malformation rupture. At issue in this appeal is whether a RT300 FES Cycle Ergometry Rehabilitation Therapy System is medically necessary for treatment of the member's condition.

      There are multiple studies in the literature that find that repetitive passive movement of the lower extremities of chronic spinal cord injury patients via functional electrical stimulation may be beneficial for spasticity, vascular perfusion and even neurologic impairment. These studies show that functional electrical stimulation can reverse disuse atrophy and increase muscle bulk in muscles below the level of an injury. However, the MAXIMUS physician consultant explained that long-term benefits and effect on health outcome from functional electrical stimulation in patients with spinal cord injuries remains unclear at this time. The physician consultant also explained that any benefits are lost if the functional electrical stimulation activity is discontinued. The consultant indicated that there is no definitive evidence that functional electrical stimulation cycle ergometry will lead to better health outcomes or functional improvement than other types of conservative treatments such as functional electrical stimulation and/or passive range of motion of the extremities. Therefore, the medical necessity of functional electrical stimulation via the RT300 system remains unproven at this time.


      Pursuant to the information set forth above and available documentation, the MAXIMUS physician consultant determined that a RT300 FES Cycle Ergometry Rehabilitation Therapy System is not medically necessary for treatment of the member's condition. (Sadowsky CL, et al. Lower extremity functional electrical stimulation cycling promotes physical and functional recovery in chronic spinal cord injury. J Spinal Cord Med. 2013 Nov;36(60:623-31. Yasar E, et al. The effect of functional electrical stimulation cycling on late functional improvement in patients with chronic incomplete spinal cord injury. Spinal Cord. 2015 Feb;17. Rayegani SM, et al. The effect of electrical passive cycling on spasticity in war veterans with spinal cord injury. Front Neural. 2011 Jun;2:39.)

      Last edited by stephen212; 13 Apr 2015, 8:36 PM.
      stephen@bike-on.com

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        #18
        We were told that BCBS wouldn't provide the RTI for people with complete injuries.

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          #19
          I think it's got a lot tougher to get these covered than it use to be and it use to be really hard as it was. That was one reason I saw the need for a low cost FES bike that people could afford but it was never able to be done.
          "Life is about how you
          respond to not only the
          challenges you're dealt but
          the challenges you seek...If
          you have no goals, no
          mountains to climb, your
          soul dies".~Liz Fordred

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            #20
            This is exactly what my startup company is working on.
            What, in your opinion, is "low cost"?

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