Wheelchair Question

[KimT]

I'm being measured for a motorized wheelchair in the next couple of weeks.
The lady with Ability Medical called me today to keep everyone in the loop (the lady who is qualifying me and the man who is measuring me for the chair.)

The lady with Ability told me there is NO WAY Medicare will provide the raise seat function for me. Is that true? If so, does anyone know a cost for adding that function.

 

[GregK]

I've seen many complaints of that. No clue on cost.

There is a Facebook group that might answer that:I use a wheelchair, so whats the problem?

 

[scaredwifetx]

Kim, I think he cost is around 1,500 and the equipment company may work with you. We had a hard time getting ours approved but I fought and it was approved. I would also email the Gleason fund. They may be willing to help you out.

 

[lgelb]

For traditional Medicare, that is true. For a Medicare Advantage or other private plan, there can be discretion on the payor's part absent a policy statement to the contrary. And some Medicaid programs are approving it.

The key is a full justification section that explains the role of the seat elevation function in non-optional daily activities at home such as toileting and distinguishes it from a convenience function.

Last I looked cash price was 3K or so. Make the DME document fully and submit it. If it's denied, ask the DME if they will ask the chair mfr for a free or discounted rate given the ALS dx. In the past, some have done things off the menu. Also, call your plan and ask for a case manager and -- pun intended --make your case, with physician/ATP assistance.

 

[azgirl]

Mine cost $3000 and Medicare denied it several times. My supplemental would not cover it either since Medicare denied it. We fought Medicare for over a year and kept getting notices for over a year. We wrote a long letter to Medicare explaining how it was medically necessary, I can try to take it out that letter for you Kim.

Finally, the bill for the $3000 stopped coming. Not sure if my letter worked or Numotion wrote it off. You definitely want the elevator seat even if you have to pay for it. Your wheelchair company will probably work with p.m. and reduce the $3000 charge.

 

[wshealey]

I just got measured for my chair last month and was told that my private insurance might not cover the lift function. If they wouldn't, it would cost me $1,200 to add to the Quantum Q6 Edge chair. I'm assuming the price varies from one model to the next.

 

[azgirl]

I found the letter I sent to Medicare which may or may not have worked, but I did not end up paying for the seat elevation. If you private message me I can send you the letter.

 

[faithandlove]

We were told the same thing, and the cost would be $1200. You will use this function. Because I fell and sprained my ankle, I need this to get my PWC up so that I can get my hair washed in the sink. I cannot take a chance using our portable shower anymore and need sponge baths.

I plan too fight this too.

Hugs,
Deb

 

[gooseberry]

I would submit documentation of your falls via your doctor to explain this is a serious medical risk to not have it.

 

[lgelb]

The terminology is such that they don't want to hear about risk as much as about benefit: "In order to do X..." And it is true that some DMEs write it off or get $ another way from the mfr so file even with traditional Medicare, I should have said.

 

[KimT]

I've done lots of research on proper wording and Kay was kind enough to show me her letter. I usually write letters for my neurologist and he just signs them. That's how I got the Trilogy approved before I really needed it. I have a very strong case because I am at a higher risk for falls due to Meniere's disease and higher risk for muscle pain from being moved due to fibromyalgia. I have documentation of a torn rotator cuff so my upper body strength is bad. I'll give it my best shot and if I don't get it I will order it anyway and try to appeal it. If I end up paying, I have no choice. I know I need the function.

 

[swalker]

I have private health insurance, which is generally much more generous in covering things than medicare.

I fought and fought to have the seat elevate function covered by them. They denied the initial request and two appeals. That process delayed getting the wheelchair by over a month.

In the end, I paid for the seat elevate function myself. That decision was made based on the input for the great folks here at the forum. What a wonderful decision it was, too.

Imagine being in a store and trying to look at something on a higher shelf. I can't do that without the seat elevate function, because I can't reach my arms over my head. Imagine being in a group of standing people (such as during our after-church social hour) and always having to look up at them. The seat elevate function brings me up to eye level.

I view the seat elevate function as an essential and am very glad that I paid for it myself. I would have been even happier if insurance would have covered it

Steve

 

[Diane H]

I just got measured for my chair last month and was told that my private insurance might not cover the lift function. If they wouldn't, it would cost me $1,200 to add to the Quantum Q6 Edge chair. I'm assuming the price varies from one model to the next.

If you are thinking of using BiPAP with Quantum Q6 Edge, insist on seeing -- not just being told-- how it will be mounted on the chair. I was directed to a Quantum Edge only to find that mounting my ventilator added 6 to 8 inches to the length of the chair. With my old chair my vent hung compactly on the backrest. The Quantum chairs all have the tilt/recline mechanism right in the middle of the seat back. Trying to mount anything there is difficult. A BiPAP may be able to fit behind the footrests but taking it on and off and dealing with the hose would be a real nuisance. You need to see how any mounting tray would work and whether it would interfere with getting the chair in and out of small rooms or a vehicle. The mid-wheel drive also had severe jerking to the side as it came to a stop. Maybe it was a lemon but I have heard from other users who have the same experience though not as severe a jerk. It took me two years to get my Quantum replaced with a Permobil and the Quantum sat unused while I prayed my 10 year old chair (I couldn't drive it anymore or update the controls) would hold out until I got the Quantum replaced.

 

[gooseberry]

Diane that is a great point. Steve had a permobil c400 I believe. When the trilogy was mounted, you lost storage and the backpack. It also made it very hard to maneuver since it added about 8 inches to the back.

 

[KimT]

Steph, Yes, that's the model Steve had. Steph was kind enough to donate it to our closet and it has been a godsend. In fact, I'll probably be using it while waiting for my chair. God bless you gooseberry. Many people who would be without are using all of Steve's equipment.