This process can be very lengthy, complicated and frustrating. We are here to help! The following is a summary of the steps to securing such equipment for your child, once the need is identified:

• The Physical Therapist (PT) consults with the parent/legal guardian to determine how the equipment will be utilized and verifies essential insurance and physician information.
• The PT contacts the insurance carrier to determine the required “participating vendor. If no “participating vendor” is required by private insurance, a list of vendors is provided to the parent.
• The PT contacts the selected vendor to schedule an appointment to determine the specifications for the equipment and to provide insurance and physician information. This appointment is scheduled during school hours and the parent is requested to attend. Preliminary measurements are taken - height, weight, and various body part lengths (e.g., seat depth).
• The PT writes a letter of medical necessity for the equipment to the vendor and copies the parent.
• The vendor provides a detailed list of the equipment to be ordered, price list, and other required documentation to the primary physician for review and signature. Once the physician has signed, the letter of medical necessity and the detailed inventory of equipment to be ordered are forwarded by the vendor to the insurance carrier for prior approval.
• Prior approval from private insurance carriers must be obtained before:

1. Submitting to Medicaid for review
2. Actually ordering the equipment

This is generally the lengthiest part of the ordering process. Insurance carriers have three options:

* Approve of the order
* Disapprove the order
* Request additional information

Private insurance carriers generally approve or deny the order within 3-6 months. Medicaid or State Aid rulings may take as long as 12 months to receive.

The parent/legal guardian and the medical equipment vendor are the only participants in this process who receive notification of approval, denial, or request for more information. The PT does not receive this information. It is your responsibility to contact the PT department once you have received this notification. Your notification to us of approval will allow the PT to take final measurements which the vendor then sends to the manufacturer(s) of the various components (frame, insert) of your child’s wheelchair.
Usually a wheelchair will be received from the manufacturer(s) within 6-8 weeks.

Please note:
Once the letter of medical necessity has been written and submitted to the vendor by the PT, it becomes the sole responsibility of the parent to verify that the vendor and insurance companies are acting in a timely manner to gain approval for the equipment to be ordered.