Reimbursement & Funding Guidelines For Special Needs Beds
Many families have succeeded in receiving funding from private insurance, Medicaid, Medicaid Waivers, or charities for special needs beds. Typically, enclosed beds are covered for repeated safety concerns such as elopement, seizures, or self-injurious behavior. The sensory and monitoring benefits that a Boogaloo provides are an added bonus but should be focused on less than the safety needs.
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Medicaid / Private Insurance
At this time you will need to self-submit the required paperwork or work with a local medical equipment supplier as we are unable to bill insurance directly. Although we can’t guarantee that your insurance will cover a Boogaloo, we will work with you to help as much as we can.
Generally, insurance will only cover a Boogaloo for significant safety concerns such as seizures, elopement, headbanging, or other well documented behaviors that could cause injury.
Here are the steps:
1 - Contact Insurance & Learn
Contact your insurance company or state Medicaid Program office to find out exactly what documentation they require to get reimbursed for a special needs enclosed bed. If you have a case manager who knows your child's history, work with them. Although a Boogaloo can address many sensory and sleep concerns, you should focus on the safety concerns that would warrant funding as injuries cost the insurance companies money. Having repeated medical history of safety issues and photo or video documentation is helpful in getting funding.
Confirm with your insurance that you can self submit. If not, contact your local durable medical equipment supplier or we can help you find a supplier who can work with your insurance.
2 - Collect & Create Documentation
Your insurance company may specify which documentation they require, but in general, you will need the following:
- Diagnostic letter and a prescription for a Boogaloo Safety Bed from your Physician. The prescription should be for a “Boogaloo Safety Bed”.
- Letter of medical necessity from your occupational therapist or doctor (or both!). We recommend making the process easier for your doctor or OT by writing your own letter of medical necessity that they can then edit and sign off on.
3 - Submit Documentation To Insurance
Check with your insurance company through your case manager or their support phone line to discuss how to self submit the documentation to get reimbursement for a Boogaloo Bed. The process varies by each insurance company.
Sometimes they may require you to work with a local durable medical equipment supplier. In this case, contact us to help you find one or if you have a favorite supplier, ask them to contact us.
4 - Expect A Denial & Be Prepared
This will vary by your insurance coverage but many families are denied the first time they try to get a special needs bed reimbursed. This is very common. Don’t give up… It’s time to rally the troops.
Write a letter of appeal (and have your doc write one too!) addressing the denial notes. Provide counter-evidence such as photographs, videos, or accurate descriptions of incidents such as their limbs getting caught in bed rails or falls. If available, include more medical records such as injuries, skin breakdown, or sleep problems.
5 - Enjoy Your Boogaloo Bed!
Insurance Reimbursement Codes
- E1399 - Misc DME Code
- E0328 - Ped hospital bed, manual
- E0329 - Ped hospital bed semi/elect
ICD-10-CM codes (Diagnosis Codes)
- Autism or Pervasive developmental disorder F84.0
- Intellectual disabilities F70-F79
- Down Syndrome Q90
- Cerebral Palsy G80
- Angelman Syndrome Q93.51
- Wandering Z91.83
The funding pathway is different for every waiver so talk to your case manager about the process. They can contact us with questions. If you’re not yet on a waiver, these are excellent programs to provide financial resources for your loved one. Typically, your child qualifies solely based on their income which means most children with disabilities will qualify. You can find out more information here- www.medicaidwaiver.org
Foundations & Grant Programs
Click here for a great list of resources
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