“A Medical Necessity” Part 1

written by James S.

I have been doing some research recently on the positive effects that bicycling can have on children and adults with disabilities. Having watched videos on the subject, read articles and listened to remarks from therapist on Youtube, everything seems to point to one conclusion. Bicycle riding is therapeutic, both mentally and physically for children as well as adults. The  problem is the cost. Most parents and adults wanting to get a recumbent tricycle or a bicycle that is made specifically for persons with disabilities can’t afford them. Carrying price tags ranging from two hundred eighty dollars for a basic tricycle to over five thousand dollars for a tandem cycle. If  a doctor and/or therapist decides that a child or adult needs the bicycle and/or tricycle for physical and emotional therapy, and tells the insurance company that it is medically necessary to help the child/adult with their therapy, then the insurance company should pay for it.  Right?

I began my search for the answer on About.com where Michel Bihari M.D. writes “ Health insurance companies provide coverage only for health-related services that they define or determine to be medically necessary.”
I have posted a link to the ABOUT.COM website Medical Necessity – Definition of Medical Necessity.

The link below is to the Free Online Medical Dictionary along with their definition of “medically necessary” and its criteria.

via medically necessary – definition of medically necessary in the Medical dictionary – by the Free Online Medical Dictionary, Thesaurus and Encyclopedia..has this definition:
Managed care adjective Referring to a covered service or treatment that is absolutely necessary to protect and enhance the health status of a Pt, and could adversely affect the Pt’s condition if omitted, in accordance with accepted standards of medical practice. See Futility.

a. Appropriate for the Sx and diagnosis or treatment of a condition, illness or injury
b. Provided for the diagnosis or the direct care and treatment of the condition, illness or injury
c. In accordance with the standards of good medical practice in the service area
d. Not primarily for the convenience of a plan member or a plan provider
e. The most appropriate level or type of service or supply which can safely be provided to the plan member.
From the criteria that is listed, a special needs bicycle,tricycle, or recumbent tricycle  seems to meet everything that is required for these to be deemed medically necessary.
This a YouTube video about Freedom concepts bikes. In the video a therapist talks about how bicycling helps children and adults with disabilities.