More Resources

Has Insurance Denied Your Request for a SleepSafe® Bed?

Find Help in Your State!

Every state has Legal Aid or Legal Services to help those who may need help but cannot afford legal representation. You may look here: http://www.lsc.gov or http://www.countyoffice.org to find contact information about legal aid or other resources in your state. There is no guarantee that the legal service agency will accept your case, however if they do, there should be no charge to you. To help increase the chance of an agency accepting your case, be fully prepared BEFORE you call them. Your DME Supplier or Provider may be able to help you when contacting an advocate.

If you seek the help of your provider, you will need to sign a HIPPA release so they can talk to others on your behalf. Help them to help you! Do your best to provide the advocate or provider or anyone else whom you will seek help and advice with a complete packet of information that should include, at a minimum, the following information:

  1. Client Information (Person who has been denied)
  2. Salesperson and manufacturer representative information (SleepSafe Beds, LLC)
  3. The notice of determination (Letter or other communication stating claim has been denied)
  4. Letters of medical necessity (Any letters that were submitted with the claim; see samples below)
  5. Cost analysis information (LCEEA)(Provide information that you have considered and exhausted ALL alternatives and why a SleepSafe bed is the lowest cost alternative to fit your specific need)
  6. Product information (Be sure to provide the exact bed you need. There is a difference between a SleepSafe (low), SleepSafe 2 (medium) and SleepSafer (high) as are the differences between a fixed/manual, semi-electric and full electric. Provide a web link to the bed model you chose, a brochure, dimensions and specifications, etc…the advocate may never have even heard of a SleepSafe bed or any other specialty bed. It is VERY IMPORTANT for all of those involved to really know all there is to know about the bed you need).

a. This may include information on ‘specialty beds’ or ‘beds for those with special needs’, which could be different than a traditional hospital bed. SleepSafe Beds fit a very specific need…to prevent danger from becoming entrapped or injured within a bed, to help prevent rolling, falling or climbing out of bed and to provide a safe sleeping environment. This information may include any studies conducted on safety issues that may be associated with a traditional hospital bed or specialty bed or why some individuals may need a specialty bed. An example is the Hospital Bed System Dimensional and Assessment Guidance to Reduce Entrapment published by the FDA. This explains the risk of entrapment in certain types of beds.

Remember: There is no guarantee that they will take your case, though they may hear the facts, review the information and investigate your case to at least discuss your legal options. The more prepared you or your vendor are when making that first call, the better your chance for success. Providing as much information as you possibly can upfront can help the advocate make a determination as to whether or not they will take the case and it can help them see that you are willing to go the distance to get this bed. It can be helpful to them to have so much of the information that will be needed in an appeal already gathered…reducing the amount of work it will take them; this could help them say YES!

Complex Child E-Magazine

Complex Child E-Magazine is a monthly online magazine written by parents of children with special healthcare needs and disabilities.  It is intended to provide medical information, along with personal experiences, in simple language that other parents can understand.  The following articles offer advice on how to beat insurance company denials:

Help getting insurance to pay for adaptive, special needs bed:
http://www.articles.complexchild.com/jan2009/00095.html

Help on writing an appeal letter:
http://www.articles.complexchild.com/00012.html

Information about general insurance and Medicaid:
http://www.complexchild.com/insurance.html

Another Resource: The National Assistive Technology Advocacy Project may also be able to offer assistance as well. The Project receives its funding through the National Institute on Disability and Rehabilitation Research, U.S. Department of Education. This project primarily directs its nationwide support services to the network of Protection and Advocacy (P&A) and Client Assistance Program attorneys and advocates who are working on AT advocacy issues. They will also provide support services to Legal Services and Legal Aid programs and to attorneys in the private bar if they are working on AT-related issues.