At NPL Home Medical, our mission is to provide custom mobility solutions and service our patient community.
Unsurprisingly, providing custom mobility solutions requires a thorough understanding of complex insurance provisions and guidelines, as well as working hand-in-hand with occupational and physical therapists.
In this blog post, our Insurance Liason, Martin Travis, introduces himself and talks about his role.
Introducing Martin
My name is Martin and I’ve been an occupational therapist for approximately 9 years, specifically in the long-term care setting with the geriatric population.
I’ve been a “floating” therapist, an evaluating therapist responsible for multiple buildings, and a therapy manager. Although time-consuming and challenging, seating and positioning evaluations became of particular interest to me. I eventually became the “go-to” guy for wheelchair and positioning evaluations. I wanted all my residents to have the best seating systems possible. It was great to see the outcomes of a proper fitting and least restrictive type of chair being utilized within their daily routines to maximize their functional potential.
I became familiar with writing Ohio Medicaid Letters of Medical Necessity and the process of identifying and addressing positioning and mobility needs became more familiar. The company that always stood out to me was NPL Home Medical, working with multiple Assistive Technology Professionals (ATPs) and Sales Reps along the way. A position within the company was opened and I was recommended to apply. The position was titled “Insurance Liaison” and applicants were recommended to have experience with evaluating custom seating and mobility. I now get to work with ATPs, using my clinical experience, to assist in identifying need and disputing unfair denials for beneficiaries who qualify for custom wheelchairs under the Ohio Administrative Code rules and regulations.
Previously, I was often confused when residents with obvious needs were denied by certain insurances. Why was it so hard to get these chairs approved, even when they appeared to meet all the right criteria?
It became known that these specific insurances were not approving or rarely approving custom wheelchairs. The denial reasons were repetitive and vague, citing unrelated policies, and were unhelpful, giving no guidance towards resolving the applicant’s complex seating and positioning needs.
Now, it’s my role to decipher these denial reasons, assist in identifying need, and challenge these insurance companies who do not appear to follow the correct Ohio Medicaid guidelines and ultimately help get the medically necessary chairs approved.
I assist the therapist and the ATP throughout all stages of the appeal process. From reviewing the certificate of medical necessity, first-level appeals to state hearings, if we feel the beneficiary meets the criteria.
Martin helps decipher the complex requirements for Custom Wheelchair eligibility in Nursing Homes
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