by Larry Harper
(Excerpted from “Vision Enhancement.”)
In the spring of 1999, I wrote a review for the journal “Vision Enhancement” of a talking scanner called VERA (Very Easy Reading Appliance) sold by Arkenstone.
Happily, I can report that in the fall of 1999 a Medicare administrative law judge ordered my HMO to provide me a VERA as treatment for my blindness.
Most consumers with vision loss are aware that requesting Medicare coverage for an assistive technology (AT) device is a long-term project. Consequently, I want to share my success which marks the first time a vision-related AT device has been judged to be both durable medical equipment and a prosthetic device.
For those who may want to pursue a similar effort, a calendar of events for my Medicare appeal is detailed below. However, it is important for everyone to understand that I am sure I would not have won my appeal without the free legal representation provided to me by the Oregon Advocacy Center.
To read the full text of my Medicare appeal victory, go to ftp://members.aol.com/cctvocrs.
Calendar of Events
11/24/1998: Submitted request letter and VERA brochure to my Kaiser Permanente physician.
11/24/1998: Physician forwarded my VERA request to the Kaiser Durable Medical Equipment (DME) Department.
11/27/1998: Kaiser DME Department denied my request.
12/2/1998: Submitted appeal to Kaiser DME Denial Department.
1/21/1999: Kaiser Member Relations Department denied my appeal and forwarded my appeal to the Medicare Center for Health Dispute Resolution (CHDR).
2/9/1999: CHDR denied my appeal.
3/9/1999: Submitted request for Medicare administrative law judge (ALJ) appeal hearing.
4/2/1999: Received CHDR notification that ALJ appeal hearing was to be scheduled.
4/20/1999: Submitted request for legal representation to Oregon Advocacy Center.
5/5/1999: Received phone notification from Oregon Advocacy Center that they would accept my case.
8/31/1999: Medicare ALJ appeal hearing (Harper vs. Kaiser).
9/30/1999: Fully favorable decision issued on appeal hearing (Harper vs. Kaiser).
11/2/1999: CHDR sent compliance period notification to Kaiser Permanente.
12/29/1999: Received phone notification from Kaiser DME Department that VERA would be ordered.
1/2/2000: CHDR compliance period ended.
1/11/2000: VERA purchase order from Kaiser received by Arkenstone.
1/28/2000: VERA delivered to Larry Harper by United Parcel Service.
Late 2000: Follow-up article about installation and use of VERA.
For referral to your region’s agency which provides free legal services for disabled consumers, contact the National Association of Protection and Advocacy Systems, Inc., 900 Second St. NE, Suite 211, Washington, DC 20002; phone (202) 408-9514; fax (202) 408-9520; http://www.protectionandadvocacy.com