"Beds designed for special-needs children must, above all else, be safe. Entrapment and falls are real concerns, especially if these vulnerable children are restless or don't have full control over their body movements..."
What does it take to keep a child safe at night? While you may have immediately thought about baby monitors and other child-safety devices, those caring for special-needs children must often fight to get insurance companies to cover medically necessary beds. At issue: the cost of providing high-quality beds that take into account a child's specific needs.
"Beds designed for special-needs children must, above all else, be safe. Entrapment and falls are real concerns, especially if these vulnerable children are restless or don't have full control over their body movements," explains Rachel Markwood, patient advocate for SleepSafe Beds, the pioneer in providing medically prescribed beds for children with special needs, particularly those with physical and cognitive disabilities.
SleepSafe Beds' patented bed systems are providing a better and safer night's sleep for children diagnosed with a wide range of conditions, including such well-known ones as Cerebral Palsy, Autism Spectrum Disorders, Cystic Fibrosis, Rett Syndrome, Muscular Dystrophy, Down Syndrome, Angelman Syndrome, Mitochondrial Disease, Aicardi Syndrome, PCDH19 Epilepsy, MPS III (Sanfilippo syndrome) and Congenital Diaphragmatic Hernia, as well as those dealing with traumatic brain injuries and tracheostomies.
"Getting insurance companies to approve a special-needs bed is rarely simple and never guaranteed," says Markwood. "It's common for people to be denied by the insurance companies on their first attempt. You could be denied several times. Persistence is generally rewarded. We encourage people to call our office if they need guidance."
Markwood says that SleepSafe Beds has, by necessity and volume, become a trusted resource in this area. The company is a nationally recognized leader in providing high-quality, customized beds for special-needs children.
She adds that, "Our staff is on the phones every day assisting parents and therapists who are trying to get insurance approvals. It's an advantage that our products meet and exceed FDA standards. All of our bed models are typically covered by private insurance and Medicaid."
Markwood stresses, that after 15 years in business, the staff has dealt with nearly every insurance-related issue. "Our office should be on the list of people you call for help. We try to know what works."
She outlines some of the steps that should be taken to navigate the insurance maze:
That's absolutely the first step. While many people find us after doing a lot of research online, most are referred to us by a healthcare specialist who recommends a special-needs bed and writes the prescription for a specific model.
If a child is already using a wheelchair or other durable medical device, there may already be a DME in the picture. However, some DMEs prefer not to handle the acquisition of safety beds. We have worked with an extensive network of DMEs who offer these beds. Many of them provide their services nationally. We can easily make appropriate referrals.
This is the most important element of the process and where you need to present your case to the insurance company. The letter must be well thought out. If you need assistance with it, our staff can connect you with professionals with experience writing successful LMNs.
While SleepSafe Beds is prohibited by law from writing Letters of Medical Necessity, the company's experts act as advisors on a daily basis. Their guidance provides important insights including:
The most common reason for insurance company denial is that they don't see any need for the safety bed. Your letter should list what you are currently using and why it won't work long term. For example, the rejection letter will often suggest putting a mattress on the floor as an alternative. If that's the case, you need to explain clearly why such strategies as putting a mattress on the floor won't work.
For example, insurance companies often suggest using hospital beds. But unlike special-needs beds, hospital beds are not designed for children vulnerable to the seven zones of entrapment*, as defined by the Food and Drug Administration.
Explain the child's need for specific requirements such as full safety rails, or specific height required for safety (where the double safety rail and mattress height adjustability of the SleepSafer model would accommodate the needs), or the necessity of articulation to raise the head or feet of the patient in order to feed, medicate or provide mobility.
DMEs, caregivers, physical therapists and physicians can all write letters to present your case to the insurance company.
If you think your letter is as good as it's going to get, and you're still being denied, insist on an in-person or phone interview with your insurance company. By law, they must have an attorney present. They may opt to approve your request rather than incur that added expense.
Helpful examples of Letters of Medical Necessity are available on the SleepSafe Beds website.
For more information about gaining insurance approval for a medically necessary special-needs bed, call 866-852-2337 or visit www.sleepsafebed.com or the SleepSafe Facebook page.
*The Food and Drug Administration has identified seven zones of bed entrapment:
Medical necessity is a United States legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care. The term clinical medical necessity is also used.
A Certificate of Medical Necessity(CMN) is a piece of paper required by Centers for Medicare and Medicaid Services to substantiate the medical necessity of an item of durable medical equipment furnished to a Medicare beneficiary. It is essentially like a detailed prescription.
A Letter of Medical Necessity (LOMN) is an essential part of a request for services, medication, or medical equipment, and can be used in a wide range of issues, such as being submitted to a private insurance company or other funding source, or a governmental agency. A Letter of Medical Necessity should contain information needed to convince the recipient that the requested service/product is necessary to meet the medical needs of the person for whom the service is being requested.