Old 11-26-2018, 07:46 PM #1 (permalink)
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Default Insurance/Medicare Coverage for Shower-Commode Chair

Iím a little over two years post diagnosis and was recently denied insurance coverage for a shower/commode chair. I am a federal employee and have been very happy with coverage thusfar (GEHA). As I prepare to appeal the denial, Iím wondering what othersí experiences have been with insurance coverage for a shower/commode chair.

The lady at my insurance company said personal hygiene items arenít covered as they donít fit their definition of durable medical equipment.

As I said above, I would appreciate some responses to see if my denial is common or rare. If you were approved and are willing to share the name of your insurance company Iíd appreciate it so I can include in my appeal letter. I am not asking for names or personal info, just the insurance company name or if it was Medicare.

Thanks
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Old 12-20-2018, 10:42 AM #2 (permalink)
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Default Re: Insurance/Medicare Coverage for Shower-Commode Chair

According to their website Medicare covers commodes. I don't know what they do when the chair can also be used for showers but I do have one on loan from my ALS association lending program. I'd love to hear what other's experience has been. Perhaps if in your appeal you emphasize the medical necessity of a commode chair this will help.
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Old 12-20-2018, 01:43 PM #3 (permalink)
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Default Re: Insurance/Medicare Coverage for Shower-Commode Chair

The appeal letter should reference the use as a commode, not for showers. Make sure the submission is being coded correctly. You may have a significant copay depending on the features of the chair but should get some reimbursement.
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Old 12-20-2018, 04:59 PM #4 (permalink)
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Default Re: Insurance/Medicare Coverage for Shower-Commode Chair

We got the basic commode day 1 which was ordered by the rehab my husband was in as he was trached and vented to start his ALS journey. Everyone I asked about a shower chair to, VNA and ALS organizations said Medicare wouldn't cover it. So from what Laurie points out , commode vs shower chair, maybe the answer. I also wonder if mentioning the need for head support and tilting function for trunk support would get you closer to a shower chair and a higher payment ? Hope you have success, Kate
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Old 12-21-2018, 06:11 PM #5 (permalink)
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Default Re: Insurance/Medicare Coverage for Shower-Commode Chair

You should also apply for a grant from your local ALSA chapter and ALS Guardian Angels.
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Old 12-22-2018, 07:57 PM #6 (permalink)
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Default Re: Insurance/Medicare Coverage for Shower-Commode Chair

We have been able to apply to our local ALS chapter for reimbursement as Kim just stated. They have grants available for equipment or other needs. Just ask the local chapter in your area. We have been highly encouraged to apply frequently for anything we spend money on that insurance will not cover.
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