Children and adults with hemiplegia or hemiparesis may use a WalkAide or Bioness device to help them with foot drop. Insurance companies may deny coverage for a variety of reasons. This page provides hints from families who’ve successfully obtained insurance coverage for the WalkAide or Bioness.
Depending on the requirements of your insurance plan, you may need to apply in advance for approval of coverage of the WalkAide or Bioness. Often this involves a letter from the neurologist requesting its coverage. The insurance company may deny coverage. When they deny they must tell you in writing why they are denying coverage. You then ask for a fair hearing to appeal.
The insurance company may deny coverage because they say the WalkAide or Bioness is not medically necessary. They may deny coverage because they say it’s experimental. At this point, you will need to appeal. The initial appeal is often in writing. Later, you may have an appeal in front of a judge. When you speak with the insurance company, write down what was said, the name and agent number, any identifying numbers for the phone call, and ask for them to send you the information in writing. The denial should be a written letter. Keep all of this information in a file.
One Family’s Story – Obtaining Insurance Coverage for the WalkAide
My son has a diagnosis of hemiplegia and has toe drop (difficulty picking up his toes when he walks). For us the insurance company denied coverage the WalkAide device once for not being medically necessary and then said it was experimental. They sent the second denial 2 days before the trial. So I did my research and went to the trial with a written version of my rebuttals so I wouldn’t forget anything. That’s when all those years of watching courtroom drama comes in handy (kidding.) Basically you have to knock down their reasoning.
I complained I was only given 2 days notice of the new denial; the judge offered to reschedule us, but I said I’d rather get it done. If I had agreed to reschedule, we may not have received coverage. The insurance representative doctor testified by phone and we sat in front of a judge.
Our rebuttal for not medically necessary. I pointed out how previously he only had minimal use of his right hand, showed a snip of video I had captured in therapy 2 years ago, and then another snip of him doing e-stim on his hand with improved function. Then handed the judge a scarf he had recently woven using both hands. After showing that e-stim was successful in his hand, I suggested that it demonstrated how walk aide could be doing the same for his leg. I also pointed out that the AFO (ankle foot orthosis) didn’t allow for the muscles to be trained. I added that his father was 6’5″, and at age 8 I could barely keep up with his growth changes. His growth required a new AFO nearly every 6-9 months because he’d outgrow them and he’d be hitting puberty soon, so that’d be even more frequent. I provided information from the orthotic provider about the insurance cost of each AFO. I demonstrated that after covering the cost of 3 or 4 AFOs, the insurance company could have simply purchased a WalkAide, which would not require replacement as he grows.
Next I attacked their claim that the WalkAide is experimental. I looked through the list the insurance company provided of 15 or so articles to deny. I pointed out all but 3 of their articles were more than 5 years old; one was 12! And then based off the titles alone I was able to eliminate 8 of them (relating to spinal cord injury, geriatric patients, nerve injury etc). I pointed out that aid of course you would consider this experimental – back when your evidence was written it was experimental. It is not longer experimental. Then I gave them a list of 10 articles given to me by the WalkAide folks and said these all relate directly to my son, and are current – within the last 2 years.
Here’s where in our case, it got really good. The doctor on phone says he needs some time to review all this info. Judge says, “Well you didn’t give Mrs. C time to review her new information. You have until 1 pm.”
We reconnected at 1 pm and the insurance company decided to make a one-time exception for him. This was Medicaid in New York.
One of my proudest days ever! Yehaw!
Other Family Experiences with Denial of WalkAide or Bioness
- Appeal the denial and have your doctor write a note that you are holding off surgery because it looks like you may be able to improve his range of motion with the use of the Walkaide – ZM
- We had clinical notes from the physical therapist and the pediatrician. I had letters of medical necessity from physical therapist and neurologist if necessary ready to be written. They also have grant programs if you have an outright denial.
- Don’t take no for an answer. An assigned caseworker with your insurance company may help. Ask for your request to go to the medical review board. Offer to submit before and after videos and PT reports. – AS
- Sometimes it takes getting to the right person that can review the case and make a decision – CK
- Make sure you appeal, and once that is exhausted ask for an external review. Ours was approved back in 2015. Our physiatrist showed that my son’s range of motion of the ankle worsened while not using the device. This was our second device – previous one needed replacement – ZM
Successful Insurance Coverage of WalkAide or Bioness
- We have Aetna and after appealing we got it covered 100%. Our orthotist told us exactly what info he wanted from us. He took a video of my son walking with no orthotic, with an AFO, and with a WalkAide. Then he sent that with a bunch of documentation stating the benefits to our insurance company if they would cover the device.
- Our daughter’s WalkAide was covered without appeal by Medicaid in Colorado. – KF
- Fight it! Took it all the way to 3rd and final appeal and won. Bioness coverage by BCBS. – CB
- Appeal! We won on the 3rd time! – BK
- Our insurance company surprisingly paid for it on first submission but we were prepared to submit several times – RM
- We appealed and got ours half funded – KS
- We had a Bioness covered by United Healthcare several years ago when my son was very young – PK
Connect with other families of children, teens and young adults with hemiplegia
