Westcoast Wire Winter 2012

Winter 2012
New Westcoast Ability Clinics
Offer Options, Expertise and Fun
Westcoast patient David Nicholson checks out a few of the bikes on hand for test rides
thanks to the VA’s Adaptive Sports Program and pro adjusters from Bicycle Outfitters.
S
aturday December 3, 2011 was of Westcoast prosthetists and orthotists and
a beautiful day for a bike ride in several physical and occupational therapists
Tampa’s Flatwoods Park, where were on hand to teach safety skills and
Westcoast Brace & Limb held the give ‘hands on’ guidance and adjustments
first of its new Ability Clinics.
where needed for
Open to anyone living with
participants. Willie
limb loss or limb deficiency
Clay, who uses
secondary to neurologic and/
bilateral leg braces,
or musculoskeletal conditions,
already is active in
—Westcoast President Greg Bauer the adaptive sports
the Clinics provide athletes at
any experience level with the opportunity community, but this was the first time he
to learn safe techniques, identify the best tried cycling. “Wow, this is really great,” Clay
equipment for their needs and enjoy physical said, after trying a few different bike styles.
activity. With the support of experts from “I can’t believe I’m doing this!” Many of
the Adaptive Sports Program at James A. the experienced participants brought their
Haley Veterans Administration and Bicycle own equipment as they regularly cycle at a
Outfitters, new and experienced riders alike competitive level. Westcoast President Greg
were fitted on a variety of the latest adaptive Bauer, LPO, CPO, said the Clinic definitely
bike styles. “This is amazing,” said Michael fulfilled its objectives. “It’s about people
Epps, an above knee amputee, trying a learning from their peers,” he said, “as well
handcycle for the first time. “It’s definitely as getting guidance from professionals and
a real work out. I love riding with the group finding a way to try out something new that
and I love being able to go down the trail works for them.”
on my own.” David Devlin also was fitted
Westcoast Brace & Limb will offer
with a handcycle during the Clinic. “My Ability Clinics throughout 2012, including
brother is always talking about how much Clinics for golf, running and swimming.
he loves riding,” Devlin said. “Now I know To see more photographs taken during the
how he feels. I want one of these!” A team event, go to www.wcbl.com.
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First-time rider Willie Clay found his
wheels and then the need...for speed!
“It’s about finding
a way to try out
something new.”
Westcoast Patient Ambassador Bobby
Puckett (l) and Doyle Mann shared
personal training tips with attendees.
For additional information,
please contact:
Jennifer Latham Robinson
WESTCOAST PATIENT PROGRAM DIRECTOR
(813) 397-5219
email: [email protected]
with other equipment, such as wheelchairs
and diabetic supplies. Many insurance
agents will incorrectly assume what devices
you are being provided, so it is imperative
to specify and describe the devices in
detail. If there is an issue, you should ask
the insurance agent how the device is being
categorized and confirm that there is no
separate category (other than DME) for the
proposed device.
Once the category of benefits has been
identified (e.g., DME, EPA), ask your
insurance representative the following
questions:
W
estcoast Care Coordinators
and Case Managers are
dedicated to supporting
patient needs by staying
on top of the most accurate and up-todate information about our patients’
insurance policies. Knowledge is power
and understanding the most commonlyused terminology is key to decoding what
your insurance policy covers in terms of
your costs and benefits.
Co-payment
A co-payment is a set dollar amount assigned
to certain types of medical procedures
or office visits. For example, your policy
might require that you pay a $30.00 copayment for your regular physician visits,
while the insurance company covers the
rest of the charges for the visit.
Co-insurance
Co-insurance is not a set dollar amount, but
is based on a percentage of overall charges
incurred. For example, if your plan specifies
20% co-insurance for x-rays, you would pay
20% of charges associated with the x-ray,
and your insurance company covers the
remaining charges. Your percentage can
be based on a discounted amount or the
“usual and customary” fee, depending on
the network status of the medical provider.
Deductibles
The deductible is the dollar amount
the insured individual must pay before
insurance coverage kicks in. Deductibles
are based on either a calendar year or plan
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• What is the deductible and does it
apply to this service?
year. Calendar year deductibles restart
every January. Plan year deductibles restart
on the plan’s anniversary date. Insurance
plans vary as to which services apply to the
deductible. Some plans may have a separate
deductible for out-of-network benefits,
which is typically much higher than the innetwork deductible amount.
Out-of-Pocket Maximum
Not every plan includes an out-of-pocket
(OOP) maximum, which establishes the
maximum amount you are responsible
for paying each year. The OOP may be
renewed each calendar or plan year, and
does not include your monthly premium.
Depending on your plan, it could include
the deductible and other out-of-pocket
costs accumulated throughout the year.
Obtaining Benefit Information
Prior to Service
Insurance benefits for orthotics and
prosthetics may be categorized as:
• Durable Medical Equipment (DME), a
very general category;
• Orthotics & Prosthetics (grouped
together);
• Orthotics (bracing, not necessarily foot
orthotics);
• Prosthetics (EPA: external prosthetic
appliances).
When orthotic and prosthetic devices are
categorized under DME, they are grouped
• What out-of-pocket costs are applied to
the deductible (if there are any)?
• What is the co-payment for this
procedure code?
• Is there any co-insurance?
• Is there an out-of-pocket maximum
amount?
• What will go towards the out-of-pocket
maximum amount for this procedure?
• Do these amounts renew each calendar
year or plan year?
• Are there any other limitations,
restrictions or exclusions for this
procedure?
• Is pre-authorization required for this
procedure?
If you are talking with someone over the
phone, it is also important to ask the name
of the person you are speaking with, and
the reference number for your phone call.
Individuals with chronic needs, like
amputation, who may switch insurance
policies (for example, with a job change),
should investigate answers to these
questions prior to signing up with a
new plan. It is always best to obtain this
information in writing, such as in a benefits
plan or booklet.
Westcoast Care Coordinators and Case
Managers are available to answer questions
related to your insurance coverage, and can
help identify financing and other resources
to make certain you get the devices and care
that meets your needs.
Neuro-Stimulation Clinic Opens
To Evaluate Adults and Children
Full Range of FES Devices Offered Only at Westcoast
WalkAide ®
Bioness L300 ®
Amputees Together of
Florida, Inc., Networking
Group Meetings
Hillsborough County
Meetings are held on the 3rd Thursday of
every month.
Location: Westcoast Brace & Limb
5311 E. Fletcher Avenue, Tampa
Time: 6:00pm - 7:30pm
Pinellas County
Meetings are held on the 1st Tuesday of
every month.
Location may vary, please check for info
on www.amputeestogether.org, or
contact Andrea Puckett at 813-397-5222
By Kristin Cummins, MS OTR/L
WESTCOAST CLINICAL SPECIALIST
IN FUNCTIONAL ELECTRICAL STIMULATION
I
f you have patients, family members
or are yourself living with leg or
hand dysfunction due to a central
nervous system disorder, such as a
stroke, there are an increasing number
of technological innovations available
to help appropriate adult and pediatric
candidates compensate and work towards
functional recovery. These new devices
provide a low level impulse of electrical
stimulation to the affected nerve, producing
a muscle contraction. They are designed to
compensate for loss of function, providing
as much independence as possible during
recovery. In addition, current research
finds that using neuro-stimulation devices
also support full recovery as a temporary
element of a therapeutic regimen.
As both an occupational therapist and
expert in functional electrical stimulation
(FES) devices, I evaluate very carefully
which patients would benefit most from
traditional treatments versus those for
whom I recommend assistive technology.
Therapists and doctors agree that the best
way to determine what will work best for
a patient is to evaluate them individually
while they try these high-tech devices
under expert supervision.
Recognizing the growing potential of
neuro-stimulation devices as well as
the importance of trained evaluation,
Westcoast Brace & Limb now offers a Neuro
Stimulation Clinic to educate and evaluate
appropriate adult and pediatric candidates.
We pre-screen attendees over the phone
and candidates attend a comprehensive
evaluation, resulting in individualized
recommendations. Those candidates who
qualify for a device continue to attend
the Clinic for in-depth training on wear
and ongoing care. Our team also focuses
on documenting outcomes measures
and shares them with a patient’s therapist
and physician to further foster our team
approach to patient recovery. Measuring
outcomes also is important in terms of
justifying a recommendation for an FES
device to a patient, a healthcare team and
to insurance companies, especially as more
and more new devices become available.
When it comes to FES device options,
only Westcoast Brace & Limb offers the
full range of FES products in the Tampa
Bay region, including the newly released
Pediatric WalkAide and Bioness L300 Plus.
If you would like more information on
Westcoast’s Neuro Stimulation Clinic, or to
schedule in-office product demonstrations
or free adult or pediatric patient screenings,
please contact me at 813-985-5000 or
[email protected].
To see the full line of FES products and
services offered at Westcoast for adult and
pediatric patients, please visit our web site
at www.wcbl.com.
Westcoast Brace & Limb
Office Locations
Corporate Office North Tampa
Mon.-Fri. 8:30 a.m.-5 p.m.
Ph: (813) 985-5000 | Fax: (813) 985-4499
5311 E. Fletcher Avenue Tampa, FL 33617
West Tampa
Mon.-Fri. 9 a.m.-5 p.m.
Ph: (813) 354-0100 | Fax: (813) 348-0629
2727 MLK Jr Blvd Suite 690
Tampa, FL 33607
Brandon
Mon.-Fri. 9 a.m.-5 p.m.
Ph: (813) 684-5525 | Fax: (813) 653-3730
620 Oakfield Drive Brandon, FL 33511
Palm Harbor
Mon.-Fri. 9 a.m.-5 p.m.
Ph: (727) 785-0100 | Fax: (727) 785-7773
3343 Tampa Road Palm Harbor, FL 34684
St. Petersburg
Mon.-Fri. 9 a.m.-5 p.m.
Ph: (727) 323-9500 | Fax: (727) 327-7626
4021 Central Avenue Suite C
St. Petersburg, FL 33713
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February is National Patient Recognition Month:
Thank you to all of our patients for entrusting us with your care!