Indiana: Vocational Rehabilitation Services

[Dmommy]

What is the name of your state (only U.S. law)? INDIANA

I receive SSD and I am functionally deaf (60% loss in both ears) but can hear with hearing aids. I have been trying to reach my occupational goal with vocrehab for over five years but they continually stall. I have contracted with them and provided whatever they've asked for and have been told I would receive a $30K small business start up grant as well as new hearing aids (I only have one barely working aid at present).

I have just completed all hearing tests and evaluations and paid out-of-pocket to see my doctor rather than one of their contracted doctors. They say they will honor his recommendations but I must go to their contracted doctor to have the hearings aids dispensed or they will not pay for them, even in part. I am under the assumption that I have the right to use my doctor and vocrehab must at least pay what they would pay a contracted doctor. Is this correct?

Thank you.

 

[Proserpina]

What is the name of your state (only U.S. law)? INDIANA

I receive SSD and I am functionally deaf (60% loss in both ears) but can hear with hearing aids. I have been trying to reach my occupational goal with vocrehab for over five years but they continually stall. I have contracted with them and provided whatever they've asked for and have been told I would receive a $30K small business start up grant as well as new hearing aids (I only have one barely working aid at present).

I have just completed all hearing tests and evaluations and paid out-of-pocket to see my doctor rather than one of their contracted doctors. They say they will honor his recommendations but I must go to their contracted doctor to have the hearings aids dispensed or they will not pay for them, even in part. I am under the assumption that I have the right to use my doctor and vocrehab must at least pay what they would pay a contracted doctor. Is this correct?

Thank you.

Yes, you have the right to go through your own doctor - and you also have the right to not receive anything at all until and unless you follow the State's guidelines.

It's not dissimilar to applying for disability; while your own physician's records are generally very helpful the State does reserve the right to demand that you see one of their doctors.

 

[Dmommy]

Yes, you have the right to go through your own doctor - and you also have the right to not receive anything at all until and unless you follow the State's guidelines.

It's not dissimilar to applying for disability; while your own physician's records are generally very helpful the State does reserve the right to demand that you see one of their doctors.

They're not asking for me to see their doctor for an exam. They have honored my doctors recommendations. They just want me to go to their doctor because he will accept their (lesser) reimbursement for the recommended hearing aids. I want to know if I can pay my doctor, provide the receipt, and VR reimburse me only what they would pay their doctor. I have checked their PPM and am trying to figure out if my answer is in this section:

600.03 INDIVIDUAL RESPONSIBILITIES

If two or more available services would meet the vocational rehabilitation needs of the individual, the least costly service establishes the maximum cost that will be paid or reimbursed by the state Vocational Rehabilitation Program. Where the least cost has been established by the program but the individual makes an informed choice to secure the goods or services at a greater cost, responsibility for the difference in cost is that of the individual and the individual's family, if applicable, and the more costly choice can be approved only if the individual or the individual's family agrees to pay for, makes arrangements to pay for, and pays all additional costs. The responsibility of the individual and family for additional costs extends to all aspects of goods and services selection and any additional services made necessary, including any additional costs incurred as a result of the individual's choice of:

(1) product or service brand, make, or model;
(2) style, options, or features;
(3) (in some instances) new versus used;
(4) the service provider, product supplier, or source, or its location;
(5) method of service provision or procurement; and
(6) any other applicable aspects of the goods and services and their procurement, provision, and delivery, where costs are incurred which exceed the least costly available goods and services.

Thank you.

 

[Proserpina]

They're not asking for me to see their doctor for an exam. They have honored my doctors recommendations. They just want me to go to their doctor because he will accept their (lesser) reimbursement for the recommended hearing aids. I want to know if I can pay my doctor, provide the receipt, and VR reimburse me only what they would pay their doctor. I have checked their PPM and am trying to figure out if my answer is in this section:

600.03 INDIVIDUAL RESPONSIBILITIES

If two or more available services would meet the vocational rehabilitation needs of the individual, the least costly service establishes the maximum cost that will be paid or reimbursed by the state Vocational Rehabilitation Program. Where the least cost has been established by the program but the individual makes an informed choice to secure the goods or services at a greater cost, responsibility for the difference in cost is that of the individual and the individual's family, if applicable, and the more costly choice can be approved only if the individual or the individual's family agrees to pay for, makes arrangements to pay for, and pays all additional costs. The responsibility of the individual and family for additional costs extends to all aspects of goods and services selection and any additional services made necessary, including any additional costs incurred as a result of the individual's choice of:

(1) product or service brand, make, or model;
(2) style, options, or features;
(3) (in some instances) new versus used;
(4) the service provider, product supplier, or source, or its location;
(5) method of service provision or procurement; and
(6) any other applicable aspects of the goods and services and their procurement, provision, and delivery, where costs are incurred which exceed the least costly available goods and services.

Thank you.

So the question becomes one of cost. Have you actually discovered Cost A (theirs) versus Cost B (yours)?

 

[OHRoadwarrior]

The point is they cannot be forced to pay that amount unless they have specifically agreed and obligated themselves to do so, beforehand.

 

[Dmommy]

So the question becomes one of cost. Have you actually discovered Cost A (theirs) versus Cost B (yours)?

I am assuming their quote is lower (mine is $5,000) but I'm willing to pay the difference so I can get the aids through my doctor.

 

[Dmommy]

The point is they cannot be forced to pay that amount unless they have specifically agreed and obligated themselves to do so, beforehand.

They have agreed to pay their contracted provider (audiologist) their agreed (contracted) amount. They just won't pay mine the same amount and let me pay the difference. But I think maybe as stated in the above PPM section, they might be required to.

Thank you.

 

[Ladyback1]

I am assuming their quote is lower (mine is $5,000) but I'm willing to pay the difference so I can get the aids through my doctor.

,

I have to ask: why is it a point of contention with you that you get them from your doctor? Would you be getting the same style, brand from their doctor?

If I desperately needed something so vital to me, and someone else was willing to pay for it, I believe that I could make myself accept the "freebie".

 

[Dmommy]

,

I have to ask: why is it a point of contention with you that you get them from your doctor? Would you be getting the same style, brand from their doctor?

If I desperately needed something so vital to me, and someone else was willing to pay for it, I believe that I could make myself accept the "freebie".

I understand. Mainly, I like my audiologist (she is at a Medical University). However, the warranty and any issues I might have with the aids would mean I needed to return to VR's contractor - who is not my doctor. Also, my audiologist includes a lot of free services like cleanings, maintainence, and batteries for one year (batteries run about $10 a month) and VR's doesn't.

The bottom line is that if I had any issues I could just make the appointment with my audiologist instead of going back to VR and getting their approval, etc. or having them involved and in any way limiting my options because of a contract. Because trust me. I've had a lot of this sort of this go on and it is extremely stressful to be caught in red tape and delays.

 

[OHRoadwarrior]

The PPM section says nothing about that. It references additional expenses. It does not create a mandate they approve a specific provider.

They have agreed to pay their contracted provider (audiologist) their agreed (contracted) amount. They just won't pay mine the same amount and let me pay the difference. But I think maybe as stated in the above PPM section, they might be required to.

Thank you.

 

[Dmommy]

The PPM section says nothing about that. It references additional expenses. It does not create a mandate they approve a specific provider.

I understand. I realize they aren't required to aprove a provider and I'm not asking them to. I just thought this section meant I have a choice of utilizing their provider (whom they'll pay directly) or mine (and reimburse me with limits): "If two or more available services would meet the vocational rehabilitation needs of the individual, the least costly service establishes the maximum cost that will be paid or reimbursed by the state Vocational Rehabilitation Program. Where the least cost has been established by the program but the individual makes an informed choice to secure the goods or services at a greater cost, responsibility for the difference in cost is that of the individual..."

My provider is the more costly of the two. I'd like to assume the responsibility of the diffrence in cost.

Thank you.

 

[csi7]

I received my new digital hearing aids to help me continue working with limited accommodations in the work place. I had the choice between two providers. I receive on-going services for my hearing aids with a simple telephone call to the provider's office and schedule an appointment within a week or two weeks, depending on vacation schedules.

I understand your desire to use your own provider. However, in dealing with agencies providing federal funding, there are additional rules that apply to your case. You may have to take the query up further the agency in order to receive the services. I would keep track of who you talk to, telephone number, extension, name, and who you are referred to.

The local representative is providing you with an agency approved provider. If there are no other providers available, and your provider is willing to accept the payment by the agency, then add the question of "How do I get this service provided by this provider" and keep it simple.

 

[commentator]

And they are not going to do this, and they have every right to tell you no, you do not get to decide whether you want to use your provider or their service. If you use their provider, they will give you the services. They are IN NO WAY mandated to give you hearing aids from the provider of your choice and pay some of the cost to a non contracted provider and let you self pay some of it. Where do you think it says they are obligated to provide you with hearing aids at all?

 

[Dmommy]

And they are not going to do this, and they have every right to tell you no, you do not get to decide whether you want to use your provider or their service. If you use their provider, they will give you the services. They are IN NO WAY mandated to give you hearing aids from the provider of your choice and pay some of the cost to a non contracted provider and let you self pay some of it. Where do you think it says they are obligated to provide you with hearing aids at all?

Well, I'll answer your question first. I understand that they are not obligated and that's fine. However, they haven't said no. I have a signed contract from them with the director's signature, in fact, that says they will provide them.

Second, I do understand that the are not required by law to pay another (out of network, so to speak) provider or myself. Again, I was just trying to understand if the section of their policies I quoted would support my request.

Thank you.

 

[Dmommy]

I received my new digital hearing aids to help me continue working with limited accommodations in the work place. I had the choice between two providers. I receive on-going services for my hearing aids with a simple telephone call to the provider's office and schedule an appointment within a week or two weeks, depending on vacation schedules.

I understand your desire to use your own provider. However, in dealing with agencies providing federal funding, there are additional rules that apply to your case. You may have to take the query up further the agency in order to receive the services. I would keep track of who you talk to, telephone number, extension, name, and who you are referred to.

The local representative is providing you with an agency approved provider. If there are no other providers available, and your provider is willing to accept the payment by the agency, then add the question of "How do I get this service provided by this provider" and keep it simple.

Thank you. And yes, I am talking with administration who is further up and keeping records. I have approached my doctor and they did try to contract with VR however, the contract reimbursement ammount was not satisfactory and my doctor's office declined. This is why I am willing to work with VR and pay the difference.

Thanks again.