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. Learn more below.
Have further questions? We'd love to help! Please reach out using the Contact Us page :)
Medicaid / Private Insurance
Thousands of families have received insurance coverage for special needs beds like Cubby. We're here to help you navigate the process :)
Although a Cubby Bed has many benefits for sleep, anxiety, and sensory regulation, insurance will typically only reimburse a pediatric safety bed for significant safety concerns such as seizures, fall risk, elopement, self injury, entrapment or other well documented behaviors that could cause injury. Here are the steps:
1 - Collect & Create Documentation
Your insurance company may specify which documentation they require, but in general you will need the following:
- A prescription for a "Cubby+ Safety Bed" from your child's physician. Explain the medical need and offer to have them reach out to us with any questions.
- You’ll also need Letters Of Medical Necessity from a physician, therapist, psychiatrist, and any other relevant medical provider who will write one. Several detailed letters are better than one.
Click here for a great guide and templates on how to write a letter of necessity.
It is the most critical piece of documentation in determining if you will get funding. Email it to us and we'd be happy to review before you submit too!
If you have a case manager who knows your child's history, work with them. Although a Cubby can address many sensory and sleep concerns for your child and relieve much stress for the caregiver, you should focus on the safety concerns of the patient that would warrant funding as injuries cost the insurance companies money. Having historical medical records, photo/video documentation, and detailed accounts of injuries, hospital visits, bills are all helpful in getting funding.
Some insurance companies do allow for self submition or reimbursement based on your receipt. This can be a much faster option as you can buy immediately and then get reimbursed after. It is worth asking your insurance company if this is possible.
2 - Connect With A DME Provider
Once you have those requirements, you or your physician will then connect with a Durable Medical Equipment (DME) provider. If you have already worked with one in the past, feel free to reach out to them. Your physician may also have suggestions or a partner organization to send your prescription to. If the DME hasn't worked with us before, have them reach out to set up an account.
If you don’t have an existing connection to an equipment provider, feel free to Contact Us and we can connect you with a partner in your area.
Call them and let them know that your loved one is medically qualified for a Cubby Bed. If you already have the prescription and LMNs, let them know. They will have some questions about your situation and to see if your loved one would qualify for reimbursement. Again, focus on safety concerns. Having the above documentation ready is helpful. Some branches may not have worked with us before either so let them know we are a registered vendor and they can reach out to us with questions. These companies are often overwhelmed with requests so stay on top of it and follow up frequently.
3 - 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 addressing the denial notes (it’s helpful if your doctor writes one as well or at least signs off on it). 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.
Get Approved And Enjoy Your Cubby!
Insurance Reimbursement HCPCS Code
Cubbys are billed as FDA registered pediatric specialty beds according to Medicaid and Medicare guidelines.
ICD-10-CM codes (Diagnosis Codes)
- Autism F84.0
- Intellectual disabilities F70-F79
- Epilepsy & Seizures G40
- Down Syndrome Q90
- Cerebral Palsy G80
- Angelman Syndrome Q93.51
- Abnormal Head Movements R25.0
- Fall From Bed W06
- Self Harm Z91.5
- Pica F98.3
- 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