POWER CHAIRS/SCOOTERS and insurance coverage
AnonymousOctober 19, 2006 at 11:39 am
I have been looking into getting a power wheelchair or a scooter and I was told by the person at the medical supply store where I might get it, that since I now use a manual wheelchair, medicare and my secondary insurance won’t pay. They will say that since I can use a manual, I don’t need a power.
Power chairs cost up to $5000, if the scooter does not meet my needs, I can’t afford one.
AnonymousOctober 19, 2006 at 12:12 pm
I dont have experience with medicare but I can tell you about a recent experience…
I called my insurance company about a manual chair and they said they would cover it 100% if it was deemed medically necessary. I asked about a power chair as well (even though I didnt need one) and asked if I found I needed a power chair or different type of manual chair and they told me they would also cover that if it was deemed mecially necessary as well.
The wheelchair store gave me a lot to stress about telling me it probably wouldnt be approved but the only way that my insurance company approved and approved quickly was to go through what they call the “proper channels” which was…
1) Have my PT give the recommendation to my Neuro for a chair.
2) Have my Neuro then write out a prescription and send it to the PT.
3) My PT then contacted a wheelchair company that was IN-NETWORK and sent the perscription over to them.
4) The IN-NETWORK wheelchair company came out to a PT appointment (I could have gone in to see them as well but convenience wise they came to my PT appointment) and discussed options and he made recommendations. I told him what I wanted as well.
5) The wheelchair company sent over to my PT options that would need to be justified beyond standard chairs (ie… ultralight model for strength and endurance issues, quick release wheels, adjustable support backrest, etc)
6) My PT completed the paperwork and actually did the medicare paperwork even though I dont have medicare as insurance companies like the standard forms I’m told.
My insurance company approved the chair and approved it so fast that I had the new chair sitting in my living room 3 weeks later! I am told that if I go through those “proper channels” again they would approve an electric chair for me again if its necessary. I dont want one and hopefully will not need one at any point but good to know they would approve it as well. Sometimes it has everything to do with the procedure followed.
AnonymousOctober 19, 2006 at 1:30 pm
I know that I could have been given the WRONG information, so I am going to get a prescription from my doctor that a power chair/scooter is MEDICALLY NECESSARY, submit it and see what happens. I may call medicare and ask them to confirm/deny what I was told.
AnonymousOctober 19, 2006 at 1:44 pm
Just a suggestion… if you are in PT it would be better to have your therapist request the chair perscription from your doctor. My insurance has loopholes where if I request the perscription myself and work directly with the wheelchair store it does not appear as medically necessary since I am requesting it not another professional in the medical field making a recommendation.
AnonymousOctober 19, 2006 at 4:25 pm
I have a power chair. It is a Pride Jazzy 600. I did alot of research on line and I ordered it from a company I found there. I had alot of trouble with the order, etc. so I would not recommend them. However, they gave me the same answer about Medicare. My records show I have a manual chair, therefore a power chair is not necessary. I would try to get your Dr. to intervene. I gave up and just got it for my 67th birthday present. I paid $4000 for mine, with free shipping and no taxes. Good luck, I love zipping around the stores and malls. I can leave the ole crabby hubby behind, just joking,, he is great, just hates shopping. Hope you find one. Regina
AnonymousOctober 23, 2006 at 10:42 pm
[COLOR=red][B]Medicare cuts payments on power w/c 11/15/06, FYI[/B][/COLOR]
[COLOR=red][B]”On October 2, 2006, CMS published its new Medicare payment amounts for power wheelchairs – and the news is grim for those with disabilities. Effective November 15, 2006, CMS will slash what Medicare will pay for a power wheelchair by up to 41%.”
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