The Affordable Care Act (ACA) & I have a love/hate relationship. Being born with a condition requiring me to use a power chair so I can be as “normal” as possible & live a full life means I live the headaches of insurance frequently. Mine, like most conditions, is considered a preexisting condition. I was thrilled when the preexisting condition non-denial provision was included in the legislation. Children being able to stay on their parents’ insurance until 26 is also great.
My back up chair celebrates its’ tenth birthday in January. 5 years is generally when things start breaking on a power chair. My wheelchair guy & head mechanic, at my provider, are constantly floored I take such excellent care of my chairs. The ACA wasn’t law when I took delivery of my backup chair; so the process was what I was used to for previous chairs.
Not so with my new chair. From office staff, at my provider not interested in doing their jobs, while my current chair died a slow death; and the hoops the ACA requires (in its current form), holy moly it was a process. I suddenly had to be brave, honest, and stand in my adult shoes more than I ever had before. To say I was uncomfortable is a gross understatement. I don’t like confrontation by nature.
Suddenly I had to yell a lot. I think I bordered on mean. However, I am a fighter. I always have been since my very first breath. It’s one of my gifts from God It’s just innate. Nothing will EVER break my spirit. To quote the MercyMe song: “The One who lives in me is greater. There will be days I lose the battle, but the cross won the war.”
The ACA required some upgrades to get what I need. In other words, to get shocks & the G Track: it helps me not tip over on uneven ground. I’ve always had, I had to get the tilt feature or the raise and lower feature. If you read my previous post you know I chose the tilt. With the touch of a button I can change my position if I’m uncomfortable. Usually, I just transferred out of my chair. Now, I don’t necessarily have to. That feature alone cost the insurance company an extra $4000. MSRP on my new wheels was $16,000. The insurance paid $12,000.
My chairs cost as much as a motor vehicle. Thank God (literally) for insurance! It’s a supply, demand, and greed problem. My wheelchair guy, when I took delivery, said, “Come with me, Stace. Here it is. Here’s what we’ve been fighting so hard & long to get. Is that what you thought $16,000 would look like?” My mouth dropped open.
No, I didn’t have to pay the difference. My provider agreed to take whatever they agreed to with my insurance during the appeal process. There is no logical reason why I have to get more features on a chair, than I need, just to get the ones I do. That is just wrong. Why force insurance companies to pay more? That’s why the appeals process was required because my insurance didn’t want to. I get it. I wouldn’t want to, either. It was stressful, annoying, and totally unnecessary. I hope in the future: the ACA gets tweaked to make adaptive equipment easier to get for everyone for in the US who needs it in order to live the fullest life possible.