Your Rights

Insurance and Appeals

If your insurance denies a request for assistive technology (AT) or related AT services, you may have the right to appeal. Review the denial notice carefully, gather supporting documentation from your healthcare provider, and follow the insurer’s appeal process within the required timelines.

Why Can Denials Occur?

• Lack of medical necessity: Insurance plans typically require that AT and AT services be deemed medically necessary to be covered. If the insurance company determines the device or service is not medically necessary, they may deny coverage.
• Excluded items: Insurance plans may have exclusions for certain types of AT devices or services. For example, a plan may not cover AT used for recreational purposes, such as a specialized bicycle or wheelchair used for sports.
• Out-of-network providers: Insurance plans may have a network of approved providers, and if you receive AT or AT services from a provider who is not in the network, the insurance company may deny coverage.
• Documentation issues: Insurance plans may require documentation from your healthcare provider to support the need for AT and AT services. This would include the prescription, evaluations, assessments, and other required forms. If the required documentation is not provided or is incomplete, the insurance company may deny coverage.
• Cost: Insurance plans may have limits on coverage amounts or may require cost-sharing, such as copays or deductibles. If the cost of the device or service is deemed too high, the insurance company may deny coverage or require you to pay a higher amount out of pocket.

Next Steps if You're Denied:

• Review the denial notice: Carefully review the denial notice from your insurance provider to understand the reasons why your claim was denied. Look for any mistakes or inaccuracies in the decision and gather any additional documentation or information that could support your claim. Pay careful attention to time limits to file an appeal.
• Contact your healthcare provider: Reach out to your healthcare provider to ask for their support in appealing the decision. Your provider can help you gather additional documentation or provide a written statement supporting your need for AT or AT services.
• File an appeal: Follow the procedures outlined by your insurance provider for filing an appeal. This may involve submitting a written request or completing a specific form. Be sure to include all relevant documentation and information to support your claim.
• Be clear and concise: In your appeal letter, be clear and concise in explaining why you believe the claim should be covered. Use specific examples and reference any medical documentation or other evidence that supports your case.
• Be persistent: Don't give up if your appeal is denied. You may be able to file additional appeals or pursue other legal options.
• Consider seeking outside help: If you are having difficulty navigating the appeals process, consider seeking outside help. This could include working with an advocate or consulting a healthcare attorney.

• Some Michigan Medicaid waiver programs may cover assistive technology (AT), home modifications, and vehicle modifications that help people with disabilities live more independently in their communities. These supports can help remove barriers at home and improve mobility and access to daily activities. Contact Disability Rights Michigan (DRM) to learn more!

• Businesses may qualify for a federal tax credit when they purchase assistive technology (AT) or make accessibility improvements for customers with disabilities. The Architectural / Transportation Tax Deduction and the Small Business Tax Credit can help offset the cost of AT, accessible communication tools, or barrier removal. Improving accessibility can benefit both your customers and your business. See: https://adata.org/factsheet/quicktips-tax

Education (School)

What if my child needs AT at school? Parents or school staff can request an AT evaluation from the school. Schools must provide an evaluation to see if your child requires AT. The need for AT devices and AT services is determined at your child’s IEP team meeting. If the team determines that your child is in need of AT or AT services, a statement of the type and amount should be included in your child’s IEP or 504 plan.

Tips:

• Make your request in writing when asking for an AT evaluation for your child.
• Make sure all AT needs are written into your child’s IEP or 504 plan.
• Your child’s right to receive AT in school, includes AT services, such as selecting or acquiring the AT device.

Employment (Workplace)

What if I need AT at work? Begin by letting your employer know that you need AT to do your job. There are several laws that require employers to accommodate and provide AT as a reasonable accommodation, including the Americans with Disability Act (ADA) and Section 504 of the Rehabilitation Act. AT that helps you do your job could possibly qualify as reasonable accommodation.

Long-Term Care Settings (Nursing Homes)

What if I need AT in a nursing home? Residents of nursing homes have the right to use assistive technology that supports their mobility, communication, and independence. Devices such as wheelchairs and communication tools can help residents participate more fully. Contact Disability Rights Michigan (DRM) to learn more!

Community and Public Access (ADA Rights)

• Under Title III of the ADA, businesses open to the public must remove barriers when it is readily achievable, meaning easily accomplished without much difficulty or expense. Simple accessibility improvements, such as installing a ramp or replacing round doorknobs with lever-style handles, can make it easier for people with disabilities to enter and use a business. These small changes can help ensure equal access to goods and services for everyone. See: https://adata.org/factsheet/small-business-and-ada-readily-achievable-requirements
• Under Title III of the ADA, businesses open to the public must ensure effective communication with customers who have disabilities. This may include providing auxiliary aids or assistive technology such as sign language interpreters, captioning, assistive listening systems, text-to-speech software, or accessible electronic documents. Effective communication helps ensure customers with disabilities have equal access to goods and services. See: https://adata.org/factsheet/communication
• The 2010 ADA regulations clarified the difference between a wheelchair and other power-driven mobility devices (OPDMD). Power wheelchairs must generally be allowed anywhere the public is permitted to go, while devices such as power scooters or golf carts may be evaluated based on legitimate safety requirements. This helps ensure people who rely on mobility devices have access to businesses and public spaces. See: https://adata.org/factsheet/wheelchairs

Disability Rights Michigan (DRM) can:

• Connect you with AT resources
• Provide you with information about your rights
• In some cases, DRM may assist you with writing appeals or filing complaints.

For additional information, visit DRM's website or call them at 800.288.5923.

About Disability Rights Michigan

Disability Rights Michigan (DRM) is the independent, private, nonprofit, nonpartisan protection and advocacy organization authorized by Federal and State law to advocate and protect the legal rights of people with disabilities in Michigan. They do not charge for their services.