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Discussion Starter · #1 ·
Heres my story. I had a motorcycle accident and I don't walk so good anymore. We discovered I can ride a bicycle with a fitness trainer for exercise. This will help me to loose weight, control my bp, ect. My doctor has submitted a request to the inusrance HMO for a new bicycle. The HMO is willing to consider the request if we can provide them with a medical identification code number to describe a bicycle when it is being reclassified as a medical piece of equipment. I realize the HMO is giving us a run around. However, Im not the first person to recieve health benefits from a bicycle. So does anyone out there know of any insurance company that has classified a bicycle as a piece of medical equipment and can you share the identification code number with me. Thank you for your time.:thumbsup:
 

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Fat'r + Slow'r than TMB
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I think your insurance company is not giving you the run around, they are just trying to make sure you don't try to get a Craig Calfee designed bike by claiming the health benefits. I know I would have already tried. After a brief search I could not find a "CPT code" for a bicycle or other piece of exercise equipment. It may be there but I could not find it. If it does exist then I think your doctor or office staff should be able to find it and or the insurance company.
 

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Resident Curmudgeon
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Try to get a Strong. Maybe the ins. co. will fall for the name as part of PT to build strength.
 

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?

tango21 said:
With his letter to the insurance company the doctor requested a Speicalized S-Works Roubaix Dura Ace bike.
Are you yankin' our chain here, or do you think your insurance company just thinks you don't really need a six thousand dollar bike to get health benefits of riding? Try submitting a request for a Trek 1000 and see what they say.
 

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back to pedaling
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Good luck with getting a bike paid for. HMO's usually have limited benefits and do not splurge for extended care products. I have gone through 2 insurance companies (company changed plans which was good for me) and each insurance company denied paying for an e-stim machine for my back even though my 3 doctors and physical therapist all wrote letters stating that I was benefiting from the machine. The company has let me keep the machine and it is still benefitting me to this day but I know if they call I will have to find a way of buying it from them.

Again good luck
 

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Scary Teddy Bear
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tango21 said:
With his letter to the insurance company the doctor requested a Speicalized S-Works Roubaix Dura Ace bike.

This has to be a complete joke. There is no insurance agency that is going to pay for bicycle that is that expensive. :rolleyes: I doubt that they will even pay for a bicycle at all, but if they do, rest assured, it will be Sora equipped.:thumbsup:
 

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physasst said:
This has to be a complete joke. There is no insurance agency that is going to pay for bicycle that is that expensive. :rolleyes: I doubt that they will even pay for a bicycle at all, but if they do, rest assured, it will be Sora equipped.:thumbsup:
I think most people know how insurance companies work and if not let me help you. You shoot for the most expensive and then if they say well we can do this but not at this price, you start to negotiate from there. Heck I received about 12 invoices from my insurance company that were all denied (stating the same reason) but each invoice was for less money, finally the company stopped billing the insurance company. Plus if you think about it, if they were to say yes, would $5,000.00 be a lot of money? Not medically speaking it would not. The e-stim machine I have sells on Ebay for ~$400, the company who gave it to me billed the insurance company $2500.00. The electrodes for it are about $10.00, they billed the insurance company$160.00 for 2 packages of electrodes and a 9 volt battery. Amazing what these companies try to get away with. Hell, my physical therapist visit (if I was uninsured was $140 for 20-30 minutes. The insurance company has a negotiated rate of $60 or something close to that (plus they get my co-pay). I could go on and on but think the point has been made.
 

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Discussion Starter · #12 ·
Roubiax

Thank you all for your input.
I belieive the reason the doctor selected the specialized roubiax was for it shock absorbing benefits. I reasoned in addition to the bikes benefits the selection of the higher end model was to allow room for the insurance company to present a counter offer. After the 4th of July weekend I will follow through with the suggestions to check with the theraputic center.
On the positive side, it doesn't hurt the ask for the bike as my doctor suggested.
the best answer is always a yes. A no, simple means Im right were I started from.
Have a great holiday weekend.:mad2: :thumbsup:
 

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Bacon!
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Good grief. I'm still trying to see why a good comfort bike like a Giant FCR series or Sedona.

And America likes to scream about the cost of their health insurance. Ugh.
 

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Discussion Starter · #18 ·
Some are getting away from the question.

Before a bicycle can be selected and PAID for, the HMO has to evaluate and approve the request. The question was for information regarding classification codes used by other insurance companies, so a bicycle could be classified under insurance company guide lines and the request for such a device can then be considered by the evaluation board. Simply including a make and model with the original request was a starting point for the doctor. Currently, the ball is in my court as the insurance company is waiting for me to come up with this classification code.

Aside from that- Yes, the Specialized S-Works Roubaix Dura-Ace is a fine high dollar item. So is a Bianchi, Cervelo, etc. A Specialized Roubaix Expert retail $3,300 is also a fine bicycle, so are Trek's Madones, Pilots, Lemonds Alpe D'Huez, etc.

You have to start some place. If you don't try your journey never begins. For now the insurance company is waiting for a letter from the doctor.

I wish to thank all who have responded for your thoughts, ideas and information.
 

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I guess I should have added this to my original reply. I can not understand why your doctor was not able to provide this code to the insurance company in the first place. This is a standard code that is found in a CPT coding manual that any doctor or billing person in their office should have a copy of.
 
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