Rehab professionals tend to be really nice people. I think we even receive discounts on car insurance because we have dedicated our lives to facilitate independence for our fellow humans. We invested lots of time and money to become professionals who focus on serving individuals with disabilities.
Because we are nice people, we tend to follow the rules, hence the discounted insurance rates. Yet, we might run into problems when the rules we are supposed to follow are not harmonious with our professional code of ethics. For example, during the evaluation process of a functionally and medically appropriate mobility device, you learn that the consumer’s insurance will not pay for the device you are prescribing. As an educated and licensed professional, you determined, through your evaluative and diagnostic skills, the mobility device, including various features, that would most benefit the consumer; the device that offers the most opportunity for independence. This is one of the tenets of our professional guidelines: provide opportunity for increased independence. Yet, the insurance company’s rules state they will not pay for it even though, in your professional opinion, it is the most appropriate device. Something is terribly wrong when the insurance industry’s rules trump our professional guidelines.
We are conditioned to be rule followers from kindergarten through most college and graduate programs. There is nothing inherently wrong with rule following, nor is there necessarily anything right about it either. If you were lucky enough to go to a good school or have interesting parents, you were also taught to think critically. If so, you have the intellectual discipline to actively and skillfully analyze, synthesize, and evaluate information gathered by a variety of ways (observation, experience, reflection, reasoning, or communication). Critical thinking scholars suggest this is a guide to our beliefs and actions. Let’s assume, as professionals, we are critical thinkers.
One way the insurance industry has taught us to follow their rules is the theme of “saving health care dollars.” In all my travels, I have honestly never met a clinician who fraudulently prescribes a piece of mobility equipment; remember, we are nice people. Wheelchair funding may be an easy target for insurance companies and the government for a few reasons. In the eyes of the insurance industry (public and private), the wheelchair does not “cure” anyone. Another reason may be the wheelchair industry does not have the financial capacity for expensive lobbyists who could sway policy. Additionally, people with disabilities do not speak out loud enough to be noticed by the policy makers.
If we are able to think for ourselves and analyze our professional tenets (facilitate independence) versus the business plan of third-party payors (make lots of money or save lots of money), we can decide whom we serve—the consumer or the insurance company.
Once again, this may sound radical, but are we not often faced with situations as stated above? I don’t suggest we break the rules, I suggest we help make the rules. As professionals, we have a duty to critically analyze the treatments provided to consumers; as Americans, we have a duty and a right to question policies that negatively affect our citizens. If you are witness to policies that appear not to make sense or seem discriminatory toward people with disabilities, they probably are.
Now that we know it is within our practice guidelines to be an advocate for the consumers we serve, how does one bring advocacy into practice? It is empowering, as professionals, to be connected with people who believe in what is important to us. Get connected to a consumer, nonprofit organization with a mission you feel passionate about. The consumer, nonprofit part is important as the government holds nonprofits with a 501c3 status to high standards. The organization should be able to guide you in the actual steps you can take to bring awareness and action to an issue that is important to you.
For example, in June over 60 consumers and approximately 100 professionals gathered in Washington, DC to participate in United Spinal’s “Roll on Capitol Hill.” As a group, we attended over 100 meetings with Representatives to talk about specific policies that affect our community. We asked for policy changes (making the rules) that will save money by facilitating independence and health. Now there is harmony.
To learn more about this event and get connected to a consumer organization making a difference locally and nationally, visit www.usersfirst.org.
Visit Ann’s blog and read more about “Roll on Capitol Hill”: www.usersfirst.org/category/usersfirst-blog/
Ann Eubank is vice president of Community initiatives of UsersFirst (usersfirst.org), a program of United Spinal Association. UsersFirst is a grassroots movement seeking to empower and amplify the voice of consumers with disabilities and health care professionals to increase access to wheeled mobility. As an adjunct faculty member at Belmont University, public speaker and writer, Ann has been immersed in the community of people who use wheelchairs for more than 20 years.
