From: Richard Webb 
Subject: mark_schowalter.parti@ecunet.org
Hello Greg and listers.
Recently, you wrote:
   >I would like to applaud Peter for his creative suggestion in
   >wanting to have a wider range of adaptive technology covered by
   >medical insurance.  Unfortunately, it would presently be very
   >difficult, if not  virtually impossible, to accomplish such a goal.
   >Indeed, at present, even persons seeking medical insurance funding
   >of a CCTV can usually expect to have to appeal through numerous
   >levels of appeal stages, even though a CCTV should  clearly be a
   >covered item.
A good explanation of the situation.  My question deals with some
later comments though, which I'll quote below.
   >Under Medicare, for a device to be covered as durable medical
   >equipment (DME), it must be able to withstand repeated use, be
   >primarily and customarily used to serve a medical purpose, be
   >generally not useful to an individual in the absence of an illness
   >or injury, be appropriate for use in the home, and be necessary and
   >reasonable for the treatment of an illness or injury or to improve
   >the functioning of a malformed body member.  The Medicare
   >requirements are typical of most insurance carriers.
   >However, most items of adaptive technology cannot be an item of DME
   >because they do not meet all of the required criteria.  For
   >instance, a reading machine, an item of adaptive technology which
   >is similar to a CCTV in purpose, is not primarily and customarily
   >used to serve a medical purpose.  The primary use of a reading
   >machine is not medical.  Doctors do not prescribe reading machines,
   >doctors do not supervise their use, and reading machines are not
   >sold by drug stores or medical supply companies.  If a reading
   >machine serves a medical purpose, than so could light probes, money
>deletia>
   >braille printers, and a host of other adaptive aids and appliances.
Here's an interesting one for you.  My significant other, I guess
you'd put it, is a diabetic.  She's not blind at the moment, but I've
found myself a few times wishing I could just have her flip me a
finger, get some blood, and run the bg check for her without having to
wake her.  I've also found a situation where I couldn't get her
conscious, and a talking blood glucose monitor would have been
helpful.  COuld she possibly argue with her insurance carriers that
because of her medical condition and my blindness, she should really
have one talking bg meter available?
   >What typically happens is that the issue turns on the requirement of the
   >person to communicate their medical needs.  Thus, an augmentative
   >communication device substitutes for the functioning of the voice
   >box, and is "medically necessary" for the treatment of the
   >individual.  Without an augmentative communications device, a
   >person who cannot otherwise communicate could try in vain for hours
   >to communicate an urgent  medical need.  By contrast, while a
   >reading machine might be used to read a drug information sheet,
   >that same information could be communicated in a few seconds by the
   >doctor, pharmacist, reader, or relative.  For these reasons, most
   >items of adaptive technology are considered to be "convenience"
   >items, and not covered by medical insurance.  However, to confuse

There again, if she's unconscious, the first thing I want to judge is
whether or not she's in need of insulin or in need of sugar.  An
adapted glucometer is available, but is spendy.  My theoretical argument also
hinges on communication of a medical need.
A knowledgeable spouse or relative could use the meter she has to
ascertain that information, and make intelligent decisions about
whether to seek help for her.
Regards,
Richard Webb
Electric Spider Productions
Net-Tamer V 1.08.1 - Test Drive
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