spinergydude

Aetna

4-30-08

SpinergyDude

Subject: Final Appeal Decision

Dear Mr. SpinergyDude:

This letter is in response to the appeal request we received on April 30, 2008. This appeal is regarding the denied predetermination request for the TiLite ZRa wheelchair and accessories supplied by Monroe Wheelchair.

A medical director, board certified in internal medicine and geriatrics, who was not involved in the original decision, participated in the review of this appeal. We reviewed all available information including:
* your correspondence,
* clinical documentation submitted,
* and Aetna Clinical Policy Bulletin Number 271.

Our Decision
Based on our review of the above information, we are reversing our previous benefit decision and will now allow benefits for this TiLite wheelchair and accessories.

Upon review of the submitted clinical documentation and the related clinical policy bulletin on wheelchairs, the prior determination is overturned. Coverage will be allowed for the requested ultra light wheelchair, special wheels/tires, and other accessories. With the diagnosis of sacroiliac dysfunction and your unique clinical situation, this wheelchair appears to provide the most benefit to support activities of daily living with the least amount of discomfort and with improved mobility.

>>My original goal was to acquire myself independence inside my home. I did not expect to also find the system as broken as I did…