Karen
This is so unfair!
You shared <<The breast pump does not qualify as durable medical equipment
eligible for reimbursement as it does not meet criteria #4 in the above
definition. The breast pump can be useful to a person in absence of sickness
or injury. There is the right to a further appeal of this determination. To
do so, please submit Clinical documentation to substatiate the above noted
criteriea for durable medical equipment has been met.>>
My 10 yr old son and I have been wracking our brains trying to get around
this loophole. We have been trying to think of another durable med equipment
[DME] that would be reimbursed but did not meet the criteria. Surely there
have been some exceptions. I would try to take this tack:
Although DME is GENERALLY not usefull to a person who unless ill or injured,
sometimes the DME may be useful during times of wellness. I would say that
FOR THIS CLIENT, the pump will not be useful during the times of wellness
[i.e. when the baby is fully recovered]. Maybe they cover an item such as a
humidifier, which could be useful to someone when the air was dry. And maybe
say something like a breastpump is only really needed during an altered
state of wellness which would include extended mother baby separation such
as a working mom, so you can not think of a time when a breastpump would
really be absolutely needed in times of wellness. I know I am not making
much sense, but this is a "riddle" that really is driving me crazy. Then
again, here is a good case for them to rewrite their criteria for covering
DME. AAAARRRRGGGHHH!

Laurie Wheeler, RN, MN, IBCLC
Violet Louisiana, s.e. USA

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