By Frank Long, MS, Editorial Director
Abla Gharib, a 60-year-old female Chicago resident who is a quadruple amputee, lost the use of her power wheelchair more than a year ago. Her $1,709 insurance premiums were up to date, and she had her physician’s support for a new mobility device. Repairs to the old wheelchair or a replacement seemed like sensible solutions.
Blue Cross and Blue Shield (BCBS) of Illinois saw it differently.
The insurer denied Gharib’s claim for repairs or a new wheelchair at least twice. She appealed, but BCBS remained intractable. The company propped up the rejections with its opinion that Gharib “might be able” to propel a manual wheelchair with what is left of her upper extremities, or “walk a little” using her lower extremity prosthetics.
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According to a report from Chicago’s CBS 2 News, BCBS stated flatly in a letter to Gharib, “[A power wheelchair] is not medically necessary.”
Missing the Obvious
In the interim, Gharib met her mobility needs with a loaner wheelchair from the wheelchair company that provided her the older, inoperable power chair. After nearly 18 months of use, the loaner chair developed problems with a broken armrest and a backrest that would not adjust.
The lower extremity prosthetics Gharib owns are of only very limited use because they damage her skin. That damage, she says, can take weeks to heal.
Gharib began to grow concerned about her prospects. Her physician did, too.
“This is a unique case. It’s very rare scenario when you find a person that has amputations involving all four limbs,” said Dr. Mark Huang, who has been Gharib’s doctor throughout her rehabilitation at Shirley Ryan AbilityLab. “It’s really critical, because if she’s not able to propel a wheelchair on her own that’s not motorized, then basically she’s going to be stuck in the wheelchair and can only propel at very short distances if at all.”
— Mark Huang, MD, Shirley Ryan Abilitylab
Better Than an LMN: Public Shame
Short on options, Gharib reached out to the Morning Insiders program on CBS 2 with a simple request: “Please help me, I’m relying on your assistance.” The program staff took Gharib’s case public and on August 6 aired a television report about the woman’s battle with BCBS of Illinois. The segment featured interviews with Gharib and included close-up views of the woman’s residual limbs, wheelchair, and prostheses.
The program was a game changer and by Monday, August 10, CBS 2 reported that BCBS of Illinois had issued a letter to Gharib confirming it would provide coverage for a motorized wheelchair. The company stipulated, however, that the elevating seat system Gharib requested would not be covered.
Morning Insiders’ complete video includes interviews with Gharib and Huang as well as additional information about Gharib’s condition.
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Your article about BCBSIL not paying for a quadruple amputee’s power chair, unfortunately, does not surprise me (as much as it saddens me). I am a PT in California and I periodically have patients that have BCBSIL as their insurance. I am contracted with BS of CA (but not Anthem), and can accept BS from any other state, but BCBS requires a separate contract, and they refuse to contract with out-of-state PTs.
I am glad that they eventually agreed to pay for the power chair (but not the power lift model??), but it shouldn’t take this kind of effort to get something so logical. Further, I am appalled that nobody has filed a lawsuit against them for this and similar actions. The insurance industry has been practicing medicine without a license for far too many years and to the detriment of far too many patients.
This must stop.
Jeff, thank you for weighing in on this. It is enough to make you tear out your hair, isn’t it (but I suggest you resist the temptation to do so)? On behalf of the rehab industry and your patients, “Thank you,” for hanging in there and providing patient care despite the abundance of frustration.
— Ed.