by Nidhy Varghese, M.D., and Erin Ely, R.N., CPN, of Texas Children’s Hospital
Adaptive seating systems, such as adaptive strollers or push chairs, are technology for children with mobility-related disabilities. They provide enhanced postural support, stability and comfort over standard infant or toddler strollers. In addition, these devices may offer enhanced versatility for a variety of conditions (e.g., indoor and outdoor movement, jogging) while folding up neatly for transport. Adaptive strollers can be adjusted to grow with the child and have a much higher weight capacity than a traditional stroller, allowing for longer use. However, adaptive strollers are often extremely expensive and are not typically covered by insurance. Another drawback for the stroller is that the child cannot experience independent mobility that a wheelchair may provide.
“In my practice, only a handful of patients use adaptive strollers,” said Nidhy Varghese, M.D. “Despite a physician prescription, multiple letters and appeals were required to get them approved by insurance. This makes the approval process quite lengthy and can delay the patient receiving their adaptive stroller.”
The important factor in the insurance coverage approval process is to spell out very clearly the reason for which the adaptive stroller is being prescribed, as well as why the patient would need this type of stroller over a traditional stroller. The process traditionally will result in a peer-to-peer conversation with the prescribing physician and the insurance company.
For children with World Health Organization Group 1 PH (pulmonary arterial hypertension, or PAH), an adaptive stroller is a reasonable consideration for the child who has outgrown a toddler stroller but continues to have mobility needs. It is especially helpful for children who are technology-dependent, since adaptive strollers can accommodate portable oxygen, ventilators, pulse oximeters and other medically necessary equipment.
Adaptive seating systems are attractive options for children with PAH because they can help maintain mobility and reduce movement-related disability and related effects on a child’s quality of life. These seating systems can allow the child to rest comfortably and securely well into adolescence. However, because adaptive seating systems are not readily approved by insurance, approval will require work by the family and the physician’s office. Delivery times also are often lengthy because each adaptive stroller or push chair is specifically adapted to a child’s size and needs.