May 12, 2017
Case Study: Your patient comes in for his scheduled visit. The exam is unremarkable and he reports he’s doing quite well. Then, right before he leaves, he insists that you give him an approval for an electric scooter so that he can shop more easily in Walmart. He explained that his neighbor has one and he thinks he should have one too. From the list below, what should you do?
Our IPA has resources to help you. Our Care Management nurses will research your questions. They review all the available medical records as well as do a thorough search on the National Coverage Database in an effort to provide you with the information you need to approve the request. If they can’t find a reason to approve, they will provide you with some of the requirements needed for the request to be covered and communicate it to you. For example, a failure of conservative management before an invasive procedure, etc.
With regard to scooters, providers must document the functional status of the patient, e.g., if he is ambulating and how much. Scooters are not meant for shopping in retail centers.
Please do NOT write a prescription for the electric scooter or at least add to the script, if you feel it should be written, “Patient requesting scooter”? The signed prescription by the PCP can be interpreted as PCP agreeing to the item/service/referral and the plan may not be able to deny the same even if the request seems as not meeting medical necessity
One does not have to agree with the patient’s request or disagree on the progress note. Just document clearly what his medical condition is and the nature of his request.
Since this patient is absolutely insisting for the desired piece of equipment, it does not help to get into an argument or in a position where one is making the decision about the need for the product.
Denials can only be made by insurance plans. We are providers and should send such requests to the plan for medical determination if we don’t think the request is a covered benefit. Similar requests, such as spas, elevators for one’s homes, out of network referrals, etc., should be addressed in similar manner.