Getting vertical is a healthy habit. Until recently, though, getting funding for a standing device was a tough sell. And many wheelers who succeeded soon lost interest, so the device ended up in a corner gathering dust. Fortunately, this trend has been changing in recent years as doctors, therapists and insurance companies are getting tuned in to the health benefits of standing. Also, the relatively small outlay for a standing device up front can save big medical costs down the road. It seems wheelers are once again passing the word that they feel better when they get vertical on a regular basis.

Dr. Douglas Garland of Rancho Los Amigos Rehab Center suggests standing to help slow the course of osteoporosis [see NM's "The Silent Bone Breaker," November 2001]--even if you haven't been standing for 10 to 15 years. But there are other benefits. "When it comes to benefits of standing, osteoporosis is the tip of the iceberg," says Mary Boegel, co-owner and president of Prime Engineering, a standing frame company based in Fresno, Calif. Boegel, an L2 para for 29 years, started developing significant contractures in her knees and hips after not standing during the first 12 years of her SCI. Aggressive physical therapy didn't help. She was facing a surgical solution when she decided to try straightening things out by standing.

"The original standing frame I was using was difficult to use and dangerous," she says. "Plus it didn't allow the incremental adjustments I needed." So she started working with Dr. Glenn Reynolds, who had polio, and her husband Bruce Boegel, to develop a standing frame that would allow her to gradually work out the contractures. The new device worked, and in two years Boegel was able to eliminate her contractures.

At the time, she was involved in wheelchair tennis. "Whenever I would have a bunch of wheelers over at my place, they would line up to try the standing frame. They would stand and get this big grin and say, 'This feels great.'" Boegel, her husband, and Reynolds took note, and soon they were making standing frames. That was the birth of Prime Engineering.

Funding standing devices has gotten better in the past four years, according to Boegel. She credits much of the improvement to aggressive education. In the past, many insurance companies didn't have a code for standing devices, so they would turn down requests. Very seldom were they challenged. Because of this, many therapists didn't prescribe them--they did not want to get a client's hopes up, only to have the request turned down.

At the same time, since the insurance companies weren't seeing many requests, they figured they were justified in denying them. But now many of the manufacturers have worked to promote funding by stressing the benefits of standing, and the cycle has begun to reverse--more companies approving standing devices, more therapists prescribing them. And consequently, more requests. In fact most private insurance companies and 50 to 70 percent of state Medicaid programs now pay for standing devices.

Boegel says two keys to successful funding are to get a prescription and a letter of medical necessity that includes at least one or more of the accepted benefits of standing: slowing the progression of osteoporosis; prevention or reduction of contractures; help with digestion and bowel and bladder function; better range of motion; and added pressure relief.

Andreas Kuhbier, President of Independence USA, makers of Lifestand standing frames, suggests a team effort between you, your doctor, your therapist, and your dealer to get funding. Kuhbier advocates taking the "I will not accept 'no' as an answer!" attitude. He says insurance companies commonly deny a request that doesn't fit the norm. Instead of giving up at that point, he suggests, "Question it, re-submit and fight it. Get your dealer involved. You have a good chance of getting a 'yes.' The other key is justification, justification, justification. 'This is why I need this device,'" he says.

Rick Klusovsky, General Manager of Levo USA standing chairs, suggests several alternative avenues of funding. "Vocational rehab is a great area to seek funding," he says. "We just got the OK on funding for a standing chair for a woman who's an operating room technician and fully intends to go back to work but needs to stand to do her job." This is an inexpensive answer.

Worker's compensation is another option. A standing chair is cheaper than lowering cabinets throughout the home. "Our perspective is to educate insurance companies that in the long run it is cheaper to fund these devices," says Klusovsky. "But if no type of insurance is an option, consider seeking out organizations that do fundraisers for this kind of thing," he says.

Another Levo client was denied funding for a standing chair through an HMO. He appealed and was denied again, so he took the HMO to court. Result? He won.

Jackie Kaufenberg, U.S. Marketing Manager for Altimate Medical standing frames, says therapists and doctors as well as funding sources are seeing fewer secondary problems related to SCI for people who stand regularly. Kaufenberg says that if you get turned down for funding, appeal, appeal, appeal!

Though almost unheard of, Medicare has paid for a standing frame or two, usually when it is listed under the "miscellaneous" code. Ronald Hall, 58, of Oxnard, Calif., is a union representative for the film industry and has been a T4-5 para for 12 years. Hall became friends with a woman in rehab who got an Altimate Medical standing frame funded through Medicare. When the woman passed away, her husband gave the device to Hall. "I stand every day for one hour after breakfast. I really notice the difference when I don't stand because my legs get stiff and my spasms get much worse. Plus standing feels good, feels as if I'm uncompressing the middle of my body," says Hall.

Richard Fronheiser, 68, of Pennsburg, Pa., has been a C5-6 quad for 6 years. Fronheiser tried out a variety of standing frames at last year's Abilities Expo in New Jersey and liked them so much he dug into his wallet and purchased a Life Stand standing chair. "I use my standing chair every day for one half-hour in the afternoon." He noticed an improvement in his health soon after he started standing. "It really helps my bowel program, helps get things moving along, and since I started standing, my hemorrhoids have completely disappeared," says Fronheiser.

Ray Greenberg, 52, a C7-8 quad for 15 years, is a peer counselor from Fresno, Calif., who has a good deal going at work; his employer owns a Prime Engineering Grandstand 3 standing frame. Greenberg wants to get a standing frame through his insurance, but in the meantime he uses his company's on his lunch break. "When I stand, I get a really good stretch in my hips, and it reduces the spasticity in my abdominal muscles. Plus the standing frame is mobile so I can wheel around and hassle my co-workers and look them eye to eye, or look down on them, which feels great," he says.

Even if you haven't been standing in quite a while, the time to start is now. Insurance companies are getting the idea that standing is a healthy habit, and funding is becoming more common. But if all avenues of funding should fail, consider posting a "standing frame wanted" ad at your local rehab center, in the back of New Mobility, or on a chat room. There are still a few people out there who want to get rid of that standing frame collecting dust in the corner.