Step One: Talk to your physical therapist
They will help connect the family and the adaptive equipment provider. The PT can help set up the appointment to try equipment and will attend the appointment if their schedule allows. The appointment can be scheduled at the adaptive equipment provider’s office or at the child’s home.
Step Two: Talk to your pediatrician
In order for the equipment to be approved, the pediatrician needs to sign off on the medical equipment. You should alert your pediatrician you will be getting a new piece of equipment that will require their signature. You must have had a visit with your pediatrician in the last 6 months from when the equipment was requested.
Step Three: Trial equipment at DME provider and decide on best fit
You and your PT will work together in determining the right piece of equipment.
Step Four: Physical therapist writes Letter of Medical Necessity (LMN)
An LMN is a very comprehensive document that details why the medical equipment is necessary.
Step Five: Adaptive equipment company submits all information to Medicaid/Insurance/CAP/C
This includes the following documents: letter of medical necessity from physical therapist, document signed by pediatrician confirming medical necessity, and equipment ordering form completed by adaptive equipment provider
Step Six: Insurance will review the documents
The review process can take weeks or months and will ultimately result in approval or denial. If request is denied, physical therapist/pediatrician can appeal within 30 days of the denial.
