Life has had so many twists and turns and my new path is just beginning to unfold. An update is long overdue. When I last posted, I was struggling with returning to being a full-time chair user and not quite sure if I was emotionally ready or willing to take that next step. I held on to the hope that two total knee replacements would solve the problem….they don’t. My knees are not the cause of my falls, just a nagging source of bad AD and a huge reminder that I am aging.
I was riding the fence about going to a seating clinic. A hard fall took me off that fence! In early April, I took a fall outside of my home just before 9 am. All the neighbors had gone to work, the last school bus had left and I lay on the ground in 30 degree weather with high winds and my cell phone just out of reach. The commercial, “Help I’ve Fallen and Can’t Get up” flashed through my mind as I struggled to reach my phone. When I reached it with my only free hand, I couldn’t remember how to make a call. After five unsuccessful attempts at reaching 911 (I kept disconnecting the phone) I finally got through to a dispatcher. She told me to not move (was she kidding?) and wait for help. I was shivering so bad that I could barely speak—human popsicle came to mind. My husband suddenly appeared as did a neighbor who is a county Sheriff. I spent the morning drifting in and out of awareness, having difficulty finding words, and thinking Boy, did I screw up. The diagnosis was bad bruises, a severe concussion, hypothermia and bruised pride. The realization was: Time to get off the fence and into a wheelchair.
In less than four weeks after the fall, I went through a wheelchair clinic, selected a chair that met my medical needs, had letters of medical necessity drafted and the paperwork submitted. I went through my insurance company and was assigned a Case Manager to help with any issues that might arise. I learned the hard way that if you are in an appeal when you get a case manager, they can not assist with the appeal. If they are in place ahead of time, they can help all you need. I was assigned to Doug, personable,laid back and good at keeping me updated. He said all documentation lookedgreat and the request for the chair was in medical review in less than 5 days after receipt. Imagine my devastation when the chair was denied immediately and completely.
Doug called me and let me know my options. Having read the documentation, he had a sense of urgency to get the denial into an appeal process. He took my file to the medical director, contacted my doctor’s office and set up a peer-to-peer review for the following week. This was the quickest way to proceed but had to be done in only 7 days and my doctor was out of town. After a flurry of emails the call was set. Coverage of the wheelchair was in the hands of my doctor. I had an internal struggle going on—wanting the chair but at the same time not wanting it. Everyone involved was leery because we had fought since 2010 to have a chair authorized. I received an email that the peer-to-peer went well and that an immediate decision would be made. A week later, the prior authorization letter and approval came. All but $800 worth of items were covered, the most significant denial was the “Frog Legs” because they were deemed a comfort item and always denied by my insurance company. Is it asking too much for a wheelchair to be comfortable?
Currently I have a loaner wheelchair, which is too big and I am unable to push or move it about the house. It doesn’t fit in our car, either, but my teenage sons are giving it a workout. The wheelchair order will be submitted next week for a CAD drawing and then assembly by Ti-Lite. I am not sure how long delivery will take but I am looking forward to increased independence and fewer falls.
Am I happy about returning to being a wheelchair user? NO! Do I accept it a bit more? Most definitely. Do I plan to maintain my ability to walk? Absolutely, if it can be done safely. Will I cry when my chair is delivered? Most likely. Three weeks from today will mark my 55th birthday as well as my 22nd year post injury. The journey has been one of change—I am anxious to see what the next 22 years bring.
Thank you, WQ