What is the name of your state? NA
I am currently working on a request for insurance approval of a Speech Generating Device (SGD) for a 59 1/2 yr old lady with ALS. She is bed confined and has little gross or fine motor movement left. She was placed on hospice care 1 year ago (hospice = 6 month life expectancy). Provider of the device refuses to rent the device & insists on a one time purchase. Evaluation by a speech pathologist indicates the patient can use the device (with difficulty) for both basic and advanced communication needs. My conserns are multiple:
1.) What defines basic communication needs for a hospice patient?
2.) Looking at definitions of "medically necessary", "custodial", and "treatment", is the SGD appropriate for a hospice patient?
3.) Given progression of the disease, ALS, how long will the device be appropriate?
4.) SGD is considered a true prosthesis rather than durable medical equipment. Is inability of speech secondary to a terminal illness a true speech disability (for which an SGD is an approved device).
5.) Is the SGD a "treatment"? I ask because hospice is palliative in nature rather than curative.
This will be unpopular, but
6.) Is an expenditure of $8,000.00+ for a potentially custodial device appropriate in a patient with a life expectancy of 6 months--on hospice?
I ask because I am truly torn. I want to approve the device as I would love this lady to be able to communicate with her family in her last days. But, by the terms of the plan--medically necessary, treatment, prosthesis, vs. dme and custodial, I cannot approve. As I say, my biggest problem is "treatment" vs. "hospice". You are good at research. Find me something, please.
lkc15507
I am currently working on a request for insurance approval of a Speech Generating Device (SGD) for a 59 1/2 yr old lady with ALS. She is bed confined and has little gross or fine motor movement left. She was placed on hospice care 1 year ago (hospice = 6 month life expectancy). Provider of the device refuses to rent the device & insists on a one time purchase. Evaluation by a speech pathologist indicates the patient can use the device (with difficulty) for both basic and advanced communication needs. My conserns are multiple:
1.) What defines basic communication needs for a hospice patient?
2.) Looking at definitions of "medically necessary", "custodial", and "treatment", is the SGD appropriate for a hospice patient?
3.) Given progression of the disease, ALS, how long will the device be appropriate?
4.) SGD is considered a true prosthesis rather than durable medical equipment. Is inability of speech secondary to a terminal illness a true speech disability (for which an SGD is an approved device).
5.) Is the SGD a "treatment"? I ask because hospice is palliative in nature rather than curative.
This will be unpopular, but
6.) Is an expenditure of $8,000.00+ for a potentially custodial device appropriate in a patient with a life expectancy of 6 months--on hospice?
I ask because I am truly torn. I want to approve the device as I would love this lady to be able to communicate with her family in her last days. But, by the terms of the plan--medically necessary, treatment, prosthesis, vs. dme and custodial, I cannot approve. As I say, my biggest problem is "treatment" vs. "hospice". You are good at research. Find me something, please.
lkc15507