insurance and fm

[Guest guest]

> I am going to appeal the decision of the insurance

>company to try to get them the fm which I feel that they truely do

>need. Does anyone here have any advice or information on research to

>use when I am preparing this appeal?

Our insurance company bought an FM system for our daughter when she

was in Early Intervention. Maybe our experience can help you. Our

insurance company suggested that I request a " policy review " to have

the FM system covered. That may be something you could do instead of

appealing the denial you already received.

I included a lot of things in my policy review request. I honestly

don't know which thing worked so I'll just list everything!

1. My cover letter emphasized the medical aspects of hearing loss:

brain development before age 6, the basic life function of

communication, and physical safety.

2. The pediatrician and audiologist each wrote a " letter of medical

necessity " for an FM system for home use. The audiologist wrote the

exact FM system she recommended. It's possible that these letters

would've been all we needed.

3. I included a xerox copy of Chapter 1 of Facilitating Hearing and

Listening in Young Children, by Carol Flexer. I highlighted the

sentences and paragraphs that most applied to my daughter. I also

jotted down Ms. Flexer's credentials for them.

4. A wrote short summary of situations where my daughter couldn't

hear me and an FM would help. (Of course I emphasized safety issues

that could cost the insurance company money!) Here are some examples

I gave: telling a child from a across the room to put down a knife;

yelling 'stop' near a busy street or 'climb down' from a tall tree or

play structure; talking in the car about what a red light means, that

fire trucks help people, and about private parts.

We got the FM when my daughter was 1 year old. Six years later we

still use it regularly in the car and for the TV. (It's also been fun

for hide and seek with her sisters, but you don't have to tell

insurance that!)

I hope this helps you get coverage.

Lori

PS One other thing that might affect you. Our insurance covered the

FM under 'durable medical equipment,' which had a maximum allowable

dollar amount. This meant we couldn't get hearing aids or other

medical devices covered for our daughter in the same calendar year as

we got the FM.