Announcement

Collapse
No announcement yet.

Veteran Adviser Vitaglide rejected

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

    Veteran Adviser Vitaglide rejected

    Thought I would keep you informed on what's going on. On July 8, I saw my doctor, talked to her about the Vitaglide and she thought it would be very beneficial on many different levels for me. Saw a great physical therapist who did my evaluation and she wrote down just about every single reason why I would need this -- she was very detailed.

    Today the PT called me to inform me that I was denied. She told me that the doctor who is head of Preventive Medicine and Rehabilitation (PMR) did not agree with her. I asked her exactly what was the language that he used.

    This is what the chief said,"'Denied because exercise equipment is only issued for cardiac rehab." The physical therapist that evaluated me does not understand why I did not meet the criteria. She honestly did not believe that I would be declined and was surprised and confused that the chief of PMR not only disagreed with her but my VA doctor (neurologist) that I have seen for the last nine years I have lived here.

    Honestly, I am not the least bit surprised. I hate to sound negative but this is all too typical of the VA and the bureaucratic doctors that make these decisions. I have never met this doctor (chief of PMR) but somehow in his wise decision-making, somehow I do not meet criteria for cardiovascular rehabilitation. I guess I will just take a few laps around the old high school track.

    And I really hate to say this but I believe the decision was based more on a personal agenda then what is right for the veteran. The only thing left I was going to ask you is there any appeal process or is this just the way it is?

    I try to avoid dealing with the VA when it comes to my personal health or even dealing with prosthetics but this just seems wrong in so many ways. Even the chief of prosthetics told me during this process that they have specific paperwork for dealing with equipment that is not normally issued.

    Well, if you have any ideas I sure would like to hear them. I would not use my PVA representative because they are too closely aligned to the hospital's final decision. I might get somewhere with my social worker, she's really great. But I don't think she would stand a chance with this doctor who refused it. Probably my best chance for having any real success is contacting my congressman. It is a last resort option, but I really don't think I have any more.

    I have documented everything from the people that I have seen, the dates and conversational notes. I am totally dumbfounded but I have to keep reminding myself this is the VA. So it's kind of hard for me to get upset. Oh, and we are also having a national health-care debate, what irony!

    Thanks for the initial help and listening to my ranting. If only my heart was little weaker then maybe I would be qualified for the equipment! I wonder why they call it Preventative Medicine and Rehabilitation...

    synbat

    #2

    This man is the man for Vets.
    Dr. Sniger...Raynham, Ma.



    Specialties Physical Medicine & Rehabilitation
    Gender Male Education Education information, including: Medical School attended, years since graduation, and Residency, are all available in the Detailed Report. Years Since
    Graduation 15 Five-Star Recognition HealthGrades Recognized and Five-Star designations are available in the Detailed Report. State License Information Licensed in Massachusetts What is Physical Medicine & Rehabilitation? Physical medicine and rehabilitation, also referred to as rehabilitation medicine, is the medical specialty concerned with diagnosing, evaluating, and treating patients with physical disabilities. A physical medicine physician, also called a physiatrist treats diseases and disorders including neck and back pain, and sports injuries or disorders resulting from trauma, such as [COLOR=blue! important][COLOR=blue! important]spinal [COLOR=blue! important]cord [/COLOR][COLOR=blue! important]injury[/COLOR][/COLOR][/COLOR] or head injury. The physiatrist works with the patient using X-rays, a [COLOR=blue! important][COLOR=blue! important]physical [COLOR=blue! important]exam[/COLOR][/COLOR][/COLOR], laboratory study, pain management and/or physical therapy, to achieve rehabilitation. The primary goal of the physiatrist is to achieve maximal restoration of physical, psychological, social and vocational function through comprehensive rehabilitation.

    Professional Experience


    Professional Affiliations/Memberships AAPMR
    APS
    Massachusetts Medical Society


    * Indicates physician-provided data.

    Comment


      #3
      Sorry to hear this, Synbat... maybe you don't have enough "points" yet ... ok, bad joke, sorry.
      get busy living or get busy dying

      Comment


        #4
        I forgot to say Dr. Sniger is SCI.

        Comment


          #5
          Hey thanks for the info. But I'm not really for sure how Dr Sniger could help in this situation. But this is far from being over. Yeah, quadvet just a few more points -- that's a good one! A little out there like Catch-22. By the way, just to clarify things when I was talking about the PVA rep, I was referring strictly to the one that I deal with here. It was not meant as a blanket statement.

          synbat

          Comment


            #6
            Go for it, looks legit to me. All the best... let us know what happens. I'm off to the VA now, speaking of...
            get busy living or get busy dying

            Comment


              #7
              1) Was this requested through your home VA, or through your VA SCI Center? If the former, you need to see if you can get it prescribed by a physician at your designated SCI Center. According to VA regulations, the SCI Center prescription should over-ride the decision of a non-SCI center physician or facility, but that may mean you have to get it from the SCI Center's PS&A department as well (on their dime, so to speak).

              2) Have you filed an appeal? You have a right to appeal this decision, and I would STRONGLY encourage you to do so with the assistance and advocacy of your PVA NSO. You can appeal this all the way up to Washington DC if you so choose. You also have the right to appear in person, with the representative of your choice, in front of the Major Medical Equipment board that has the responsibility for review and approval of these requests locally. I used to sit on ours, and it is your right, and often decisions are changed.

              Your PVA NSO is paid to be your representative by the national PVA. They are not paid by the VA. If you don't think your PVA NSO is doing their job, or is siding with the hospital and not acting as your advocate, you can contact Bo Rollins at the PVA headquarters and he will take action.

              The VA DOES purchase and provide exercise equipment (for example, standing frames and gliders, weight machines such as the Uppertoner, even weight sets and pulley systems)! I suspect this PM&R (Physical Medicine and Rehabilitation, not preventive) physician is confusing VA eligilibity with Medicare, and that he has a private practice outside the VA that has gotten him confused.

              (KLD)
              The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

              Comment


                #8
                KLD,

                First of all, thank you for all the information. I went through my home VA or VA Healthcare System. Although, they may not be a SCI center, the physician is a neurologist and she's really good. The hospital itself has been totally overhauled and is a really nice facility with a strong budget.

                The last time I dealt with a PVA NSO was about three years ago when the same doctor denied me for a wheelchair that would actually fit. The PVA officer basically threw her hands up in the air and said there wasn't much she could do. I could not believe it! At that point I should have contacted someone higher up in the PVA and reported her at the same time.

                Long story short, I took the matter in my own hands, contacted my congressman and both of my senators and working through a Congressman's liaison officer at the VA the matter was resolved -- I received a wheelchair that fit my lifestyle. I am sorry to say, with few exceptions, this is the VA I have come to know.

                Most likely I will contact the PVA today but I will not rule out my congressman. Resolution seems to be expedited when a politician gets involved.

                Once again I appreciate the information and the suggestions. It can get very frustrating when you jump through all the hoops, and all the i's and t's are dotted but one person in power decides what equipment is effective. I suspect this PM&R physician knows exactly what he is doing. He has said some things in the past that lets say do not reflect well upon his character or a doctor in his field of medicine.

                synbat

                Comment


                  #9
                  This is why I suggested him....good luck.

                  William Sniger, M.D.

                  Physical Medicine and Rehabilitation Specialist
                  360 Pleasant Street, Raynham, MA 02767
                  (508) 822-1293 Fax: (508) 822-1293


                  Dr. Sniger is a physician who became paralyzed from a spinal cord injury. He received his B.S. from the University of Massachusetts. He received his medical degree from the University of Massachusetts Medical School and completed a residency in Physical Medicine and Rehabilitation at Boston University. He completed an additional Harvard Medical School fellowship in Spinal Cord Injury Medicine at the Brockton/West Roxbury Veterans Administration Medical Center. He is board-certified in Physical Medicine and Rehabilitation and is one of only 180 physicians in the United States to be board-certified in Spinal Cord Injury Medicine. He is doing Independent Medical Evaluations (IMEs) for disabled veterans. As a specialist in Physical Medicine and Rehabilitation, he is extensively qualified to evaluate any type of disability. He is a member of the Paralyzed Veterans of America and has worked with attorneys who represent veterans.

                  Comment


                    #10
                    Originally posted by synbat View Post
                    Thought I would keep you informed on what's going on. On July 8, I saw my doctor, talked to her about the Vitaglide and she thought it would be very beneficial on many different levels for me. Saw a great physical therapist who did my evaluation and she wrote down just about every single reason why I would need this -- she was very detailed.

                    Today the PT called me to inform me that I was denied. She told me that the doctor who is head of Preventive Medicine and Rehabilitation (PMR) did not agree with her. I asked her exactly what was the language that he used.

                    This is what the chief said,"'Denied because exercise equipment is only issued for cardiac rehab."
                    Synbat,

                    Sorry to hear about your being denied, but all is not lost.

                    Here's a link to my article explaining the clinical appeals process.

                    https://www.carecure.net/forum/showthread.php?t=111445

                    Essentially, you should pursue reconsideration by the VAMC Director and, if necessary, VISN Director. Veterans often either don't know about this process or don't want to expend the energy to deal with it, which is why many VA's are also unfamiliar with the clinical appeals process as well (my VA Prosthetics Dept. would often concede rather than deal with the paperwork whenever I'd filed a formal clinical appeal on behalf of clients). But you now know about it, and you have options. As long as your treating physician and therapist support this prescription you have the law, or VA directive in this case, on your side.

                    My advice is to start by getting something from the Vitaglide company that helps your case and file a clinical appeal in accordance with my article. The Vitaglide brochure, for starters, says nothing about it being strictly prescribed for cardio conditions. In fact, it's touted as a solution for shoulder pain more than anything else. Cardio is just one of the benefits. That PM&R doc could not be more wrong if that was the sole basis of his denial. Read for yourself http://www.grouprmt.com/vitaglide/brochure.pdf

                    Keep up the good fight and keep us posted, Synbat
                    Last edited by Veteran Advisor; 6 Aug 2009, 12:53 AM.

                    Comment


                      #11
                      Originally posted by Veteran Advisor View Post
                      Synbat,

                      As long as your treating physician and therapist support this prescription you have the law, or VA directive in this case, on your side.

                      In fact, it's touted as a solution for shoulder pain more than anything else. Cardio is just one of the benefits. That PM&R doc could not be more wrong if that was the sole basis of his denial. Read for yourself http://www.grouprmt.com/vitaglide/brochure.pdf

                      Keep up the good fight and keep us posted, Synbat
                      I would have responded sooner but first I needed to gather all the facts. I contacted my PVA NSO after reading these responses. Yesterday she saw the chief of PT and the chief of PM&R. The chief of PM&R told her that he had every right to deny the equipment because it did not fall underneath cardiovascular rehabilitation. I guess he is a real piece of work (that is an understatement)! The chief of PT -- took my PVA rep off to the side -- told her that the script that was written by my physician needed to say that it was for cardiac reasons. Then I could get the equipment.

                      I will say that my physician only wrote up the order in general terms of getting a Vitaglide. However, the physical therapist that evaluated me wrote down half a dozen reasons why. Also, the PVA NSO, informed me that I either need to have the script re-written (cardiac problems) or I would have to be involved in sports recreation. She said those were the two requirements that she did not have to work with. By the way, she used all the information that you gave me. I don't get it!

                      I can't help feel that she was rolled over, the PVA rep. Nicest lady in the world but I don't believe that she truly understands how to use her influence to its full capacity. She had to contact a few different people to get these VHA directives exactly straight. No problem there, but I knew a few people she was referring to and they are sharp as a knife. I'm scratching my head wondering why I did not refer to these individuals first -- they are PVA but in different states.

                      I am beginning to understand more of the appellate process but I don't think my PVA NOS thinks she has enough to go on. My doctor ordered it, a physical therapist evaluated me and in her opinion thought this piece of physical therapy equipment would be very beneficial. One doctor with the stroke of a pen, in one sentence denied and nullified it. Is this enough to start the appellate process? If so, what will it take for my PVA rep to get this moving. Last week she was fired up and was ready to have VISN become involved. That has all changed now, according to her.

                      Thanks for all the advice. I am one not to let things go unless I'm wrong. Veteran Adviser one of the VHA directives she used that you furnished was off by a few digits instead of 1173.06 it is 1173.08. Now that is what she said and as far as I know wrote up. It is the same wording under k. Rehabilitative and/or Recreational Equipment... no big deal. But she had her i's dotted and her t's crossed. What's up? Besides a doctor with a Napoleon complex (PM&R).

                      synbat

                      Comment


                        #12
                        Synbat,

                        You don't have to "fight" or go through the appeal process for this, in my opinion. Justification is there, just you are barking up the wrong tree with the folks you're dealing with. Again, my opinion. It is the responsibility of the VA to provide justified equipment, such as in this case. You just have to find the person(s) assigned that responsibility. The absolute most direct route I have found is a Physical Therapist at an SCI Center. They are the most likely to have prescribed this for the reasons you need it, and should have no problem pushing it through for you. If they're not agreeable, take your justification on up the chain of command in that SCI Center; make them do their job. Write or fax the Chief of Spinal Cord a complete explanation with justification, and what you plan to do if your needs aren't met i.e.; contact Congresspersons, etc.. A word about that, I wrote and got assistance from my Congressman years ago, yet when I requested help again, I was told by his VA liaison that too many requests lead to being considered "crying wolf", and wouldn't help me a second time. This was years ago, maybe they are more helpful now. But still, I've had much better results dealing directly and entirely with my SCI Center, regarding my SCI related needs, which is what you are asking for. I personally have had better luck going this route than getting PVA, patient advocacy etc. involved; it gets too complicated for them and they tend to go by VA recommendations, rather than learn all the intricacies of the situation and act on that. This is my experience, your mileage may vary. It isn't a matter of luck, it's their job! All the best, keep us posted, others may be having the same problem.
                        get busy living or get busy dying

                        Comment


                          #13
                          quadvet,

                          There is definitely miles on these wheels. I don't look for any battles or fights but when conflict does arrive, wrong person. This has nothing to do with getting the equipment the easy way, the backdoor or simply going through prosthetics. It has everything to do with a doctor who has screwed with a lot of veterans -- many of which never argue their cases. Now it's just come down to a matter of principle and going through channels.

                          Speaking of, in the past I have contacted not just my congressman but also my senators. In fact one senator in particular has helped me in the past. A roommate of mine, from way back when became a Congressman's aid out in Oregon. He was instrumental if I ever had a problem. It's been a little while but this is something actually good.

                          Right now I already have a outline draft that will be going to my congressman, my two senators (one who is on the Armed Services Committee), the DOH, to start the list. The letter will contain dates, names and parts of my medical record, for example; the explanation of why it was denied.

                          I understand that it would be much easier to go through my spinal cord center that is located in another state but this VAMC is more than equipped to deal with my situation. I found from past experience, sometimes the only way to remedy the situation is to skip the chain of command and start at the top.

                          Plus I really would not want to find myself as one of the majority. Take it easy.

                          Comment


                            #14
                            I hear you re: "miles on these wheels", synbat, we've both been at it close to the same amount of time. In fact, a big "thanks" to you for getting after this doctor, I hope it helps lots of veterans by doing so.

                            Wish we could have got together when you were out this way, could have done some damage .

                            All the best, please let us know when you get your machine.

                            By the way, I'm very fond the your Hell On Wheels patch, having worn the Old Ironsides patch for three years back in the day. However, this was my favorite variation of the patch...
                            Last edited by quadvet; 18 Nov 2009, 5:49 AM.
                            get busy living or get busy dying

                            Comment


                              #15
                              Vitaglide Update

                              I want to keep Veteran Adviser, KLD and anyone else interested updated on the Vitaglide situation that started earlier this summer. I contacted my PVA NSO and we started a little journey down the road of the VA Clinical Appeals Process. The first thing that I needed to do was to get all of my medical records that were pertinent to the case. Next, I was able to track down the product manager for Vitaglide to see what his thoughts were and what he might be able to do. He in turn, wrote this fabulous letter; simple, to the point and no BS. All of this took approximately 3 1/2 months -- I am referring to the paperwork alone. This week it will be going to the Director of the Hospital.

                              The paperwork was laid out in a report fashion: 1) Clinical Appeals Process Letter, Subject -- Denied Exercise Equipment, 2) Reference List, 3) Medical Record Copy -- doctors denial of requested medical equipment, 4) Medical Record Copy -- physical therapists evaluation and recommendation, 5) Letter from Vitaglide's Product Manager, 6) Vitaglide Article -- third-party, 7) Vitaglide Brochure.

                              A few comments about the paperwork that was submitted. First of all, the letter that I wrote to appeal the decision was based on fact and no emotion. This is easier said than done especially when you know all of the players. But getting to the point and laying it out cold is the attention grabber. The medical records took a little while to get but persistence pays off. Don't think for a minute they are going to make it easy for you. However, being polite and wearing a smile sometimes can move mountains. Getting a hold of the product manager for Vitaglide and what he was able to help me with will be instrumental. For example, he sent me a great article by Dr. Patrick Jacobs that goes into shoulder pain and how the device alleviates this major problem for people in chairs.

                              Last but not least have a little faith and a lot of patience. I know I probably could've gotten this resolved much quicker going through a congressman and senators. The one major reason I chose the avenue of using the appeals process with a PVA NSO was to ensure that my voice was heard. Going through a congressman they may just give you what you want and that is the end of the problem. No messy paperwork just give the man what he wants. The appeals process guarantees that you get a fair chance at making your case. Also, it is supposed to get to the bottom of the problem so this will not happen to you or other vets again.

                              During this time I learned a great deal about the appeals process. Also discovered that most of the people that became involved in this either had no idea what was going on or their learning curve was extremely on the slow side. This means do not assume anything. Even my PVA officer had a great deal to learn. And going slow and getting it right is more important than expediency, that is if you have the time.

                              One other thing that helped me was documentation. I am not talking about getting copies of my medical records. Instead, I am referring to writing down every important detail that affects me at the VA and my daily life. You need to have dates and names to start with. I can not write with my dexterity so I carry around a little tape recorder. If somebody does not want me to record them, (e.g. a meeting) I will bring a personal assistant to write things down. Many times I'm actually making sure he/she gets the correct information. In some ways that makes you the screenwriter, director and producer all-in-one. This way the only person you have to blame is the one looking back in the mirror at you.

                              I hope this helps some veteran that is looking for a recourse when they believe they have not had due process when wronged. Also, once again I would like to thank Veteran Adviser and KLD. I was almost convinced to do it another way but now this gives me the chance to have a peace of mind. I have not won the appeal, in fact the battle has just started now. I am confident of the outcome even if I get turned down the first time. The case will just keep going up a higher ladder. When all is said and done, at the end of the day there will be accountability.

                              Synbat

                              You can stand me up at the gates of hell but I won't back down.
                              Tom Petty

                              Comment

                              Working...
                              X