A New Wheelchair

A.C. is a young woman with developmental disabilities who needed a new wheelchair. A.C.’s mother and guardian knew just what kind of wheelchair would meet her daughter’s medical needs. But difficulties arose when various durable medical equipment companies did not conduct thorough evaluations of A.C., and therefore did not recommend the kind of wheelchair that A.C. needed. A.C.’s case was more complex than other cases, and therefore her needs were more complex as well.

Protection and Advocacy had the opportunity to represent A.C. in an internal review conducted by the particular Salud company involved. This Salud company had issued several previous denials of the wheelchair requested by A.C.’s guardian and primary care physician. Protection and Advocacy and A.C.’s guardian had worked together to gather additional evidence to present at the review. Protection and Advocacy argued that the $18,000 wheelchair being requested was medically necessary for A.C. while the $6,000 wheelchair that had been approved was not medically appropriate for this client.

As a result, the Salud company reversed its decision in support of A.C. obtaining the more expensive but medically necessary wheelchair. A.C. will be receiving her new wheelchair soon, and we are glad to have played a small part in her ability to obtain it.