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Due
to the high cost of many high tech devices, the majority of
these products are purchased through a “third party payment system.” Before
embarking on the complexities of this reimbursement system, it
is very important to point out that direct consumer purchase
(private pay) is always an option.
Funding for
a piece of technology is
about resource allocation. Persons with disabilities, along
with their support network, can directly
purchase, using their own funds, almost any piece of AT. When
using their own resources, they should have a much quicker purchasing
experience (do not need to wait for third party approvals)
and
can often negotiate
a lower price, (as a private pay sale represents
substantially less paperwork and overhead for the vendor than
a third party
payment
sale).
If there are
insufficient resources available for private pay, than the person
needs to involve a “third party payer”.
The term third payer comes from the type of commercial transaction
taking
place. The person with a disability may be the “end
user,”
but they are not the payer. The seller (manufacturer
or supplier) is actually “selling” the
product to a “third
party” – the
agency responsible for providing the funds for purchase, but
not the actual “end user”.
One of the
biggest barriers to accessible technology, is figuring out the “third
party payment system.” There are
multiple potential sources of funding, from both public and
private agencies.
Each program has its own coverage criteria and its own process
for requesting funding. In an effort to insure the end user
is getting
an “appropriate” solution, most third party payers
require submission of justification of need. Most agencies
require involvement
of a professional to determine and justify the need. As a professional
being requested to submit requests for funding, it is critical
to understand each agency’s “mandate” and
the required submission processes.
Experience
in seeking funding is a wonderful teacher. Look
for other professionals who been successful in securing funding.
Always keep
the consumer informed and try and give each consumer as much
power as the system allows.
Several commonly
used payment sources are outlined below. In addition to the overview
descriptions of
frequently used third
party payers,
there are several “guides to funding” – to
find “tips” from
others who have had more experience.
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