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Navigating the Insurance Maze to Secure a Safe Bed for Your Special-Needs Child

  • Synopsis: Published: 2017-01-09 - Article assists parents with special-needs children navigate the medical necessity and insurance maze when it comes to providing a safe bed for their child. For further information pertaining to this article contact: SleepSafe at sleepsafebed.com.

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Quote: "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.

Tips to Help You Select the Right Bed for Your Special Needs Child

  • What specific behavior or health condition are you trying to address for your special needs child with this bed? For example, a special needs child who has a seizure condition will need padding, while a special needs child who has had a tracheotomy the ability to raise the head of the bed by a specific number of degrees.
  • Height of the mattress: Consider a mattress height that will comfortably and safely transfer the special needs child to a wheelchair or other device for therapy.
  • How much space exists between the mattress and bed? Entrapment is a very real concern. SleepSafe Beds are designed so that the space between the side rails, head boards and foot boards and the mattress is nearly non-existent even when the mattress is compressed.
  • Bed foundation: Does the mattress need to be fixed or movable for your needs?
  • Navigate the insurance maze: Look for beds that meet specific FDA criteria. These stand a better chance of being approved.

Navigating insurance company approval

"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."

A prescription doesn't guarantee insurance company coverage

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:

  • Get a prescription for the bed.

    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.

  • Contact a Durable Medical Equipment provider (DME).

    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.

  • Submit a Letter of Medical Necessity (LMN) to your insurance company.

    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.

How to improve your Letter of Medical Necessity

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:

  • Address the insurance company's objections.

    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.

  • Describe why a suggested alternative solution is not a safe solution.

    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.

  • Recommend the bed model that addresses each of the concerns.

    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.

  • Write as many letters as possible.

    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:

  • Zone 1. Within the rail.
  • Zone 2. Under the rail, between the rail supports, or next to a single rail support.
  • Zone 3. Between the rail and the mattress.
  • Zone 4. Under the rail, at the ends of the rail.
  • Zone 5. Between split bed rails.
  • Zone 6. Between the end of the rail and the side edge of the headboard or footboard.
  • Zone 7. Between the headboard or footboard and the mattress end.

Learn More About Medical Necessity

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.

Related Information:

  1. Height Adjustable Examination Beds in Doctors Surgeries for Disability Access - Doctors surgeries to have height adjustable examination beds for better access to medical care for people with a disability - Australian Human Rights Commission
  2. Sudden Infant Death Syndrome (SIDS) and Unsafe Bedding - Nearly 55% of U.S. infants are placed to sleep with bedding that increases risk of sudden infant death syndrome or SIDS - NIH/National Institute of Child Health and Human Development
  3. Children with Autism and Associated Sleep Disorders - Article examines various sleep related disorders often experienced by children on the autism spectrum - Disabled World


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