Obtaining a Therapy Victory Chair through Insurance

In most cases, the cost of a TVChair stander will be covered by the insurance provider, although many reports suggest the insurer may reject the initial request, yet will accept a subsequent appeal.  Use of the following guidelines will give the insurance company information from which to evaluate the necessity of a stander for home use.

PLEASE NOTE: Before considering the purchase of a TVChair stander, a physician must approve that standing is medically safe for the user.

The initial step in seeking authorization for funding from an insurance company is to obtain a letter of justification and medical necessity from a physical therapist to be forwarded to the provider.  This letter should include the following information:

• Clients name, date of birth, height & weight

• Description of disability and level of function

• Current therapy program

• Prescribed home therapy stander use (number of minutes, times per week, etc.)

• Benefits of stander use to patient

• Functional goal of stander use

• Pros of using a stander as compared to other less costly methods

• Signatures of physician and therapist

It is advisable to include any supporting documentation as well.

Advice on Funding:

"Parents always ask for hints, suggestions and recommendations on how to deal with funding issues. The best advice is, do not be afraid of a fight! Get used to the idea of doing battle with payer sources to get what your child needs. I have found that, unless the piece of assistive technology is a wheelchair, most insurance companies, including Medicaid, will deny rather than approve your first attempt at funding. Appealing the denial may take more time, but if you stay the course and have the support of the supplier and therapist (who may need to write a second Letter of Medical Necessity), most of the time, you will get an approval."

Mark P. Warner, PT, ATP