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tripete

Very helpful member
Joined
Dec 5, 2014
Messages
1,002
Reason
PALS
Diagnosis
12/2014
Country
US
State
PA
City
Lancaster
At clinic yesterday it was decided that I need to have a chair ordered. As many of you know I had bought a cheap collapsible power chair on Craigslist and had re-designed that battery system to make it so that the batteries could stay on it when folded. I would like one of the new lighter ones that use better batteries, is more comfortable etc..

At clinic they want me to get a large chair like most PALS have. They stated that Midicare will only buy you one chair and that they do not want me to waste my medicare on one that wont possibly meet long term needs. I told them that plain out I will not be able to use a large chair as my house doors are to small and I cannot buy a van to transport it. I also believe that as I am respiratory onset that I will not need all of the support most PALS require of a chair. This of course became an argument that took my insistence before they would listen and have agreed to find me what I want.

The question is, does anyone know what Collapsible Power Chairs are paid for by medicare?

I have looked online and cannot seem to find a "master" list of approved chairs. The ALS association here doesn't seem to know how to proceed and is waiting on me to send them a list.

I appreciate your help.
 
We bought an EZ Lite cruiser out of pocket for $2500. We have since added a head rest for $145. It made sense for us and right now is meeting his needs. He is being measured for a large, regular power chair next week, but we plan to continue to use the EZ Lite Cruiser as long as possible. I can get it in and out of the car easily. It fits like a dream in a trunk and we have travelled by plane with it. When he was still walking some, I just stowed in our trunk, so if we were out and about, we could make unscheduled stops easily. It gave us some spontaneity back! If you can swing the cost at all, it is totally worth it!!!!
 
I am aware of all the ones that are out of pocket. What I need is one medicare will pay for. It is ridiculous that Medicare and the doctors are telling me what I need. I am getting very frustrated.
 
I think the key is finding a doctor who will write the Rx so that it is clear that you need a power chair but your home cannot accommodate a large chair. If you buy a chair from a company that doesn't participate in Medicare, Medicare won't approve it.
 
Hey Pete, in the meantime, you might want to see if your local ALS chapter has one in their loaner closet so you don't have to go without while researching. We had to borrow one for my dad and it was very nice and was able to fit through the doorways. It saved him a lot of energy going from room to room.
 
check this out... https://www.medicare.gov/supplierdirectory/results.html?loc=ZIP|17603|40.0144597|-76.3289941|0&filters=catg|M07ZZ$mpart|0&sort=15|ASC&paging=1|10&prtlname=&rnd=2|false&mftrname=&mdlname=&viewmap=0
 
Try searching for the Medicare supplier directory. I think I'm unable to post a link but it's medicare dot gov forward slash supplierdirectory forwardslash
 
Did you contact EZ Lite Cruiser to see if they work with Medicare? My husband is so happy with his...and so am I. It's not a back-breaker to get it in and out of the car and has put off the need for a wheelchair van. Since moving last week, we are out for a walk every morning for an hour--he pushes it the first few minutes and when he gets too tired, rides it the rest of the trip. The dog loves it, too! (She gets out a lot more now!)

We did pay out of pocket, figuring we'd save our Medicare funds for the big chair, but the EZ Lite Cruiser folks were extremely helpful--might be worth a contact.
 
My ALS nurse said only one was covered the Invacare 9000 which is essentially what I have and modified. I decided that the whole system is worthless and I am done with it. I have had to do everything myself and I will continue to. I am going to build my own chair, the he11 with them!
 
I'm sorry this is so difficult for you Pete :(
 
I am sorry your nurse didn't educate you on the different models available. The big 2 are Permobil and Quantum. Hope you can get one that works for you.
 
Pete, you only need a larger chair for when you go out for long periods. You could take out the middle row of seats in a van, have a portable ramp and drive on in. Your modified chair could be used indoors. I purchased caeabiners in many sizes to attach things to steves chairs.
 
There is no list of "not paid for" wheelchairs or "paid for" chairs. There are only codes for chairs, each of which is reimbursed a certain amount + set amounts for any authorized add-ons. For example, a random search on such chairs turned up the SmartChair, coded K0823 (Group 2 power chair, ). There are several. A purchase will be reimbursed the allowed amount for that code -- no more, no less. An approved DME has to bill you no more than 20% of that set price, if you've met your deductible (this is if you have traditional Medicare, not an Advantage plan).

The key is, does the chair have a code? The mfr has to get one. It's not automatic. Some Web sites show you the code right off.

The folding/portable chairs aren't the most complex, as your clinic noted. They don't have tilt/recline/elevation. So they don't cost nearly as much in cash, and the cash price may well be less than the time/copay that buying one through Medicare would entail.

Can you outlive your need for a better chair? Since you don't plan to use BiPAP during the day, it's quite possible, but more importantly, it's a bet no one but you should decide to make or not. It's also true, as Steph noted, that you could have an "outdoor" chair, but no one but you knows what all that entails. I would certainly look at paratransit options in your area before you decide.

Best,
Laurie
 
Pete, I'm so sorry this has become such an obstacle and frustration for you.

One note on the EZ Lite Cruiser--we got the larger model with 5-position recline, the optional head-rest and will add leg extensions that elevate when needed. I use carabiners to attach his Trilogy. I'll check on Medicare code tomorrow.
 
I should clarify that to get any Medicare reimbursement for a coded item, prior auth (as required for some items, and coming ~next year for some power chairs), approved vendor and the approval criteria/process all still apply.
 
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