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The carrot and stick: Getting Medicare/insurance to cover your Bioness or WalkAide for foot drop

October 9, 2013 2:25 am

These e-stim systems lift the foot and can free you from AFO braces… but they’re nearly impossible to get covered

 

Carrot and stick

Yet another injustice is being done to the stroke community due to endless government red tape and greed from the medical industry.

It seems that walking with a healthy gait and preventing treacherous, constant falls and balance issues due to drop foot should be a significant priority for doctors of stroke survivors and the medical community.

Like Drew, many stroke survivors have drop foot, which is characterized by weakness or paralysis of the muscles involved in lifting the front part of the foot. Drop foot causes a stroke survivor to either drag the foot and toes or engage in a high-stepping walk called steppage gait, or both.

But there are other options. And these options are pretty fantastic, like I wrote about in my previous post: Breaking out of the cast-like AFO: WalkAide and Bioness L300. These electrical stimulation (e-stim) systems wrap around the calf and send low-level e-stim to activate nerves and muscles that lift the foot.

Basically, they shock your nerves and lift up the foot so you can walk more naturally, with increased speed and improved balance. With the WalkAide, you can even walk barefoot and you can wear almost any type of shoe you please… instead of being limited to wide sneakers to accommodate a cumbersome AFO.

Drew had trials for both. And for both, he had to pay about $100 or more for one week of use.

The hefty price for these devices is between about $4,600  (WalkAide not including monthly electrodes of $70 per pack) to  up to $7,000 (Bioness).

After paying for the trial, his Blue Cross Blue Shield shitty insurance plan wouldn’t cover either device, nor would Medicaid. And the representatives working with him weren’t at all helpful in providing options.

It was a slice of hope and independence that was dangled in front of his nose, and then quickly snatched away with no options on how to get it back.

Fast forward six months. Drew is employed, has better Blue Cross Blue Shield coverage and is on a trial work period for Social Security Disability, thus he is on Medicare for that time. We hoped his new health insurance policy would cover this, or Medicare.

We’re going to try very hard to get it covered. But according to several medical representatives from Wright & Filipis, WalkAide and Bioness, it is very difficult to get these insurances to cover the stiflingly expensive devices. Hence my point that government red tape and corporate greed is keeping these wonderful e-stim systems for foot drop away from ALL (as of press time) stroke survivors who are at least financially comfortable.

According to the medical representatives that I’ve been working with, WalkAide and Bioness L300 have the same security code. Blue Cross Blue Shield considers them “experimental treatment” and will not cover for a stroke diagnosis  of CVA, cerebral vascular accident.

Medicare will cover the devices on a case-by-case basis, but again, not for a CVA diagnosis, aka STROKE. So a product that aides foot drop from stroke is not covered for stroke by Medicare.

According to the reps, Michigan No Fault auto insurance will cover it for auto accident victims, as well as vocational rehab if you’re planning on going back to work and can prove it to the corporate gods and the government.

For Medicare to cover either of the two, a survivor has to meet a rigorous 10-point criteria set forth by the government. This applies to Bioness L 300 as well.

To start, there has to be an incomplete spinal cord injury diagnosis. We’re shooting for this angle. Drew has the rare spinal stroke. He had a stroke, but instead of the blood clot going on to damage his brain, it stopped in his spinal cord and did some permanent damage, causing an incomplete spinal cord injury.

But that’s not enough according to the 10-point criteria. It includes 32 consecutive physical therapy visits with the device. But the Bioness or Walkaide will not loan or even rent you the devices. So if you can get 32 therapy visits, you have to find a therapy center with the device for your training.

From the mouths of medical reps

Here are a few notes from the medical reps on how difficult it is to get the devices covered by insurance:

Me: If you find that his insurance cannot cover (Bioness, WalkAide), can you please give me some other options?

Wright & Fillipis rep: Blue Cross is still considering this technology as experimental.  Thus they will not cover the item.  Trust me when I say this is just as frustrating for you as it is for me.

The only option is to purchase the unit at retail cost. Some patients of mine have used care credit to obtain the funds.

Me: Okay, so just to be clear, Medicare and BCBS will not cover this and there is no other way to obtain it for Drew other than cash? Will this change in the near future?

Wright & Fillipis rep: Technically Medicare has coverage criteria but as we have realized that it is next to impossible to meet this criteria.  BCBSM does not cover this currently.

Me: I spoke with a rep from Bioness and he said Bioness is covered under Medicare, except not for a CVA diagnosis. Drew has a spinal cord infarct, which is a spinal cord injury. And we could get a script that says that. I understand that Bioness and Walkaide have the same code of E0770.

Does the fact that Drew has spinal cord infarct change your answer on the Walkaid/Bioness being approved?

Wright & Phillipis rep: This does not change my answer on whether either of them would be covered.  A spinal cord injury is only one piece of the coverage criteria.  The rep may not be fully aware.  Part of the coverage criteria requires a certain number of P.T. visits with a similar device. It’s still very tricky to navigate coverage on these items.  I just don’t want you to end up with a large bill.

Bioness rep: The L300 can be covered by Medicare  only if the client has a diagnosis of Incomplete Spinal Cord Injury.  And even still, it is very difficult…..and you don’t really know until the end of the 32 PT visits, if they will pay or not.  . Other than Incomplete SCI, Medicare does NOT pay for the Bioness Technology.     Occasionally, other insurances will pay, but it’s on a case by case basis…..and generally they do NOT pay.  In Michigan, your auto insurance will pay, but it needs to be an auto accident.   Also, Vocational Rehab will pay, but the client needs to be a candidate to go back to work.  I agree with everything that x from Wright & Phillipis has stated…It’s an uphill  battle….that we continue to fight daily at Bioness.

Walkaide rep: WalkAide has been approved on a case by case basis – and it’s usually a fight through the appeals process. You usually have to get some timed Walking tests, and show the WalkAide is better than the brace or nothing…

——

As our dear friend Ira Coulston, co-founder of Walk the Line to Spinal Cord Injury Recovery rehab center says, “You’re not going to get anything if you don’t keep asking for it.”

We’re going to push as hard as we can to get the Walkaide for Drew. This technology shouldn’t be limited to people who are financially content. It should be available to all stroke survivors with ease. Walking safely shouldn’t require a dog and pony show.

 

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