Finally, Help Through the Funding Maze. . .
Illinois Assistive Technology Program Funding Manual

Developing a Funding Strategy

• The Search for Funding
• Steps to a Funding Request

Finding a way to pay for assistive technology is the major obstacle to getting and using it. It is possible that several funding sources can help. It depends on their requirements and your situation. Finding the right funding agent and getting a "yes" is rarely easy. It takes effort and resolve. Get ready. Your success is directly related to your persistence, attention to detail and how well you understand the bureaucratic process.

There is no one right way to get assistive technology funded. Finding the right source(s) depend on many factors:

• Age
• Specific diagnosis or disability
• Education or employment status
• Impact of the assistive device
• Where you will use it
• Insurance coverage
• Income
• Geographic location, etc.

Develop a funding strategy that includes finding sources and ways to convince them that AT will improve your chances of success. Use the steps below.

Steps to a Funding Request

Step one: Define the need(s)
Step two: Identify the equipment and/or services needed
Step three: Determine if alternative equipment will meet the need.
Step four: Determine funding sources
Step five: Document need(s) & secure prescriptions/ justification
Step six: Collect and submit the required paperwork
Step seven: Authorization.
Step eight: Search for co-payment options
Step nine: The appeals process.

The next few pages examine each step and offer specific suggestions to improve your chances of getting a "yes."

Step one: Define the need(s)

This step involves naming the areas in which technology can help you. You probably already have some idea about where assistive technology can give you greater access to society. You need to be able to describe that need in order to begin.

Focus on your functional needs. What do you want/need to do that you cannot currently do? Will you be better able to do it with some change in the environment or with a device? What have you tried before and why did it fail?

Step two: Identify the equipment and/or services needed.

Once you identify your need, you must find the assistive technology and related services to fill this need. These specific recommendations usually come from the professionals (physicians, physical therapists, occupational therapists, speech pathologists, etc.). They may come in a written evaluation, a medical prescription, or some other form the funding source requires. Some likely funding sources like Medicaid and Medicare only purchase equipment from Durable Medical Equipment (DME) dealers that sign up to be vendors. If you plan to use them, you'll need to find an approved dealer. Some questions to ask at this step are:

• What assistive technology will let me do what I want/need to do?
• Where can I get it? How much does it cost? Is renting better than buying?
• How do I get the prescription, training and follow-up services I need?
• Who can help justify the medical necessity (or provide other information the funding source requires)?
• What kind of help will the vendor or manufacturer provide?
• Can I get a case manager to help me? If so, how?
• Who else can I get help from?

Step three: Determine if alternative equipment will meet the need.

Funding sources look more favorably on requests for Fords than Cadillacs. See if a lower cost option will work. If you can show that you've looked around and made a wise choice the likelihood of a "yes" is better. Be prepared. It accelerates the process.

Charges must be at a reasonable and customary rate. Funders want to know the device is cost effective. How can you know? Ask the following questions:

• Would making this device be cheaper than buying it?
• Can I get it from an "equipment loan closet" or library?
• Is the cost reasonable compared to its benefit?
• Does it cost more than other options?
• Does the item serve the same purpose as another device already available to me?

If no other device meets your particular need, be sure to document it. However, do not let the cost of a device prevent you from asking for the right device, or adaptation. Ask for what will do the job adequately. Ask for a good solid Chevy, something that will do the job. Don't ask for a Mercedes. Matching technology and need in a responsible way is one key to success.

Step four: Determine funding sources.

Now that you know what you need, start looking for funding sources. You may choose to pay for it yourself and avoid the bureaucracy. However, if you cannot, there may be public agencies whose purpose is to help, or private organizations willing to assist.

Will private insurance pay for technology? It depends on your policy and each policy is different. Get to know your insurance policy, what is says, what it excludes and its definitions.1

Are you eligible for public funding? If so, from what agencies? Do these agencies restrict what they pay? Does your particular disability qualify you for their services?

The Americans with Disabilities Act (ADA), requires employers, state agencies, local businesses and public places be open to everyone. They must provide a "reasonable accommodation" for people with disabilities to use them. The mandate includes post-secondary educational institutions that receive federal funds.

Will private sources help? There are many, but they are hard to find and even harder to approach. Keep in mind, private sources can have narrow eligibility requirements and limited funds.

Can you get a personal loan for the technology? Can you afford it? Perhaps you could use a loan if all the public wells run dry. Unfortunately, it's a rare victory, to get a bank to finance assistive technology. However, the Illinois State Treasurers Office operates the "Ready Access Program." It makes low-interest loans to people with disabilities and families for assistive technology and/or home or vehicle modifications. 2

Make a list of most likely funding sources and then rank them on a scale of "most likely to pay." Then if your primary choice leaves you empty handed, other options await. Be well-prepared; with choices, documentation, and determination.

Ask for help if you need it. Ask your Durable Medical Equipment (DME) dealer, case manager, social worker, case worker, health care professional, or one of the professionals that assessed your need. Use all supports available. 3

At this stage ask these questions:

• Was the agency/person helpful before? Did I get what I needed?
• Did problems arise?
• Do I have a contact person?
• Is more than one funding source available? 4
• Will a vendor be my advocate and provide pre-approval and billing services?
• Where can I turn for hints and suggestions?
• Will the device or service let me get or continue employment? 5
• Can I live more independently or improve my overall health? 6
• Can I get copies rules, mandates or policies from the sources? 7
• Can two different funding sources coordinate payment to equal or approach the total cost?
• Will workers' compensation insurance pay for the device?
• Did this need occur because of an auto accident or negligence? Will someone else's insurance cover the
  device?
• Can local civic/charitable organizations, foundations or associations help me raise the money?

Traditional sources that provide funding for assistive technology are in a period of adjustment and are clearly nervous about setting a precedent. If a device you need is new to the market, the funding source will likely take a conservative "hands-off" stand. Plan your strategy with that in mind. Show patience and respect when dealing with a possible funding source.

Incorporate these hints into your relationship with potential funders:

• Be polite and pleasant, and always business-like.
• Write down all communication and keep a copy for yourself.
• Follow-up phone calls with a written summary of the conversation.
• Stay connected. Do not permit long gaps between contacts.
• Direct all your letters or calls to the same person.
• Cooperate. Be willing to provide proof of medical necessity (or other funding mandate) and how the technology will benefit both you and the funding source.
• Educate and inform.
• Be assertive.
• Emphasize the long- term benefits to the funding source.
• Never threaten legal action, unless you know they are discriminating against you. This is an often-heard threat and certainly does not intimidate any agency or insurance company.
• When someone (a case manager, therapist, Durable Medical Equipment (DME) dealer, etc.) goes out of the way to help, express your sincere thanks and appreciation.
• Thoroughly document all written and verbal communications.
• Remain patient and gracious. At the same time, be determined and brave.
• Document, document, document.8

Step five: Document the need(s) and secure necessary prescriptions and other justification.

Now it's time to document your need. It is one thing to know that you need assistive technology; it is another thing to prove that need to someone else. Let professionals develop this documentation . . . a teacher, speech therapist, physical therapist, occupational therapist, assistive technology technician, or a rehabilitation engineer. You may need information from a combination of professionals. Check the rules.

You must demonstrate and document your need. Below is a list of common supportive materials that most funding sources require:

• Physician's prescription (equipment, device and/or services). Medicare, Medicaid and other medically oriented sources require you to meet its interpretation of medical necessity to get approval for the device. The physician must provide a signed prescription. Funders may also require the physician to write a letter explaining the medical necessity. 9
• Letters of medical necessity from other professionals involved in the case (physical therapist, occupational therapist, speech therapist, etc.).
• General information about your functional status, medical diagnosis or other specific information.
• Literature about the device with details of how it helps you.
• Observations about your functional skills without the device and how it will improve with it.
• Reasons why the device is the least costly alternative to get the desired result.
• Details of particular situations where your health/life were in jeopardy because you didn't have the device or service.
• Equipment specifications including cost and photograph or catalog picture. A photograph showing how it helps (optional).

Other material might include:

• Your age, disability, employment status, income level, etc.
• Family status including parents, children, family physician, etc.
• Other insurance coverage.
• Your level of education, including the highest grade level reached, special education service, etc.
• A list of other services you receive.

Step six: Collect and submit the required paperwork.

The case manager, DME dealer, or advocate will typically gather and complete all the paperwork. Be closely involved, and remain closely involved. Know what you need and include all the information on the first request. Some sources might ask you to resubmit your request with changes, particularly on expensive items.

If the request meets all the necessary requirements and you have submitted all the necessary paperwork, you can now wait for the decision.

Step Seven: Going for the approval.

The funding sources' rules determine how you will learn of its decision. Find out how they notify before you submit the paperwork. Medicaid/Public Aid sends a "prior approval form" to the vendor who submitted the claim. Schools pay once the child's IEP team lists it on the Individualized Education Program.

Step eight: Search for co-payment options.

Do you have an option if the funder does not approve the total cost? If you must pay for a portion of the assistive technology, where will it come from? Can you get a personal or home equity loan? Typically, private insurance companies will not cover devices if a public agency has the mandate to purchase.

Insurance companies do not pay the entire amount, eighty percent is typical. If you cannot afford the co-payment, look for private community and charitable organizations.

Step nine: The appeals process (. . . and what if they say no?!).

If you get a denial . . . appeal! It is a fairly common practice in the assistive technology field. Funding sources don't know about assistive technology. They don't approve things that they don't know about.

Find out if they denied your claim because they lacked information or money. If they need more information, find it and send it in. Make sure it gets in the right hands, don't leave it to chance. If you don't have an advocate yet, this is a good time to ask for one.

Appeals are time-consuming. Hunt for ways to shorten your wait. Respond quickly to requests for information, sign where you should, keep copies of EVERYTHING, dot your "I's" and cross your "T's."

It's frustrating to hear that the thing you need is "not medically necessary" or "not covered." Remember, traditional funding sources are conservative. To dodge this bullet, make sure you satisfy the definition of medical need as defined by your provider. 10

New technologies enters the market at a much faster rate than the funds to pay for them; it's costly to develop new and innovative technology. Funding sources often deny new innovations hoping to avoid setting a precedent. It is discouraging. . . but persistence pays and squeaky wheels do get greased. The more you push, the more likely you get what you need.

Do not give up. Keep trying. Prove to them it is part of their mandate to you, that the device helps you, and it is a cost-effective choice.

Unless you're asking for something they purchase on a regular basis, it won't be quick or easy. Challenge their decisions. Make them prove to you that it's not covered, not the other way around. Everyone has the legal right and responsibility to advocate for him/herself. Start today.

Funding Manual TOC | IATP Home Page

1. See "Persistence Pays . . .Getting A "Yes" From Your Insurance Company" [back to text ]
2. See Part II, for Ready Access Information [back to text ]
3. The vendor stands to make money. He/she should be willing to help.[back to text]
4. Part II contains contact information and eligibility requirements for common funding sources. [back to text ]
5. This is a prerequisite for funding from Vocational Rehabilitation. [back to text ]
6. Some sources make you prove this benefit.[back to text ]
7. Medicare, Medicaid, Blue Cross/Blue Shield, HMO, etc.[back to text ]
8. See Appendix II for checklists and forms to help you document. [back to text ]
9. Medical Necessity exists when the item is a part of the physician's course of treatment and when a physician is supervising its use directly. A therapist or other appropriate individual can deliver the treatment, but the treatment has to be prescribed by a physician.[back to text ]
10. Definitions differ from company to company and policy to policy. Read the rules (or policy) regarding your coverage . . . know their definitions. [back to text ]