How to get fully electric, reverse Trelendenberg bed?

[MupstateNY]

The DME vendors in my county generally don't submit to Medicare, saying that if they did, they would end up going out of business because Medicare reimb. rates are so low. One does submit, but they can only get me a partial electric.

My insurance co. says my neuro should request prior auth and then I should request reimb. (which might not cover 100%, I'm ok with that). But when I did this for my Lumex Walkabout Junior Rollator with Seat, Small & Narrow Walker, it took ages to figure out exactly how to fill out the request form correctly. (Needed junior narrow bc of tiny bathroom.)

I found a cheat sheet about bed coding but it looks trickier than the rollator (which I eventually figured out from a similar cheat sheet for rollators and through iterations with ins.).

Can anyone help me figure this out? One way is, if you got this item through, could you look at your prior auth request form (your dr's office should be able to send it to you) or call ins. co. and have them read you the codes and description. My neuro is good at the rest of the form.

I'd like to get a bed that can go lower than most because I'm really tired of being 10" above my spouse's bed (right up against mine). We already have risers for his bed. But this is not a deal breaker.

 

[swalker]

When I looked into getting a hospital bed, I found the DME providers near me to not be helpful. They would provide a basic bed with some manual and some power functions that had a basic mattress, regardless of what my doctor wrote up.

Through our visits to Yellowstone National Park, my wife and I became friends with someone whose husband had succumbed to ALS. After his death, she donated his hospital bed to the ALSA.

The bed was very cumbersome to move and required negotiating a very tight hallway and flight of stairs to remove it. It was so hard to remove the bed from the house that the ALSA essentially stored it where it was in her house.

After several years, she was ready for the bed to be gone.

I had been thinking about a hospital bed (mostly trying to figure out ways to avoid getting one) for about 2 years at that point. I had seriously been looking for one for about 3 months.

When we found out she wanted to get rid of hers, we agreed to take it. She contacted the ALSA and they agreed it could go to me (it was officially ALSA's bed at that point).

We paid to have the bed extracted from her house, transported 100 miles to our house, and then moved into our house. It was not cheap, totalling over $2000 for the job. The bed is very heavy (over 400 pounds) and required 4 professional movers to lift it.

This bed has power head, legs, elevate, as well as Trendelenburg and reverse Trendelenburg movements. It has a special mattress that can be set to automatically adjust pressure to reduce occurance of bed sores.

It was originally a very expensive bed (I believe it retailed for well over $20,000). The bed has been absolutely wonderful. It is quite old by now and there are a couple of minor issues that do not affect how I use it. These issues were caused by damage incurred when the bed was moved into our house.

That is how we got my hospital bed. It is one of the two most essential pieces of equipment I use (the other being the bipap). Though it sure is beginning to seem like all the equipment I have is moving closer to being essential now.

Don't underestimate the value of having power bed elevate. That feature makes it easy to position the bed so that my wife (a physical therapist) can do effective range of motion exercises on my shoulders and hips.

Steve

 

[lgelb]

Mupstate, your bed has to be a couple of inches from his bed, anyway, because it has to go up and down, bend and tilt. And you really want enough room for someone to provide care from that side. All in all, it might be time for him to get a new bed if you are trying to match heights because even the bed you describe may not go low enough to meet your needs. The "really low" ones are generally really pricey.

You can also use the mattress and overlay heights you and he select to come closer to matching up.

For the benefit of readers other than the OP, it's essential to have a bed that elevates so you can get a Hoyer underneath, as well as for care, urinal use, etc. Tilt, head, torso and lower body elevation are for positioning. Trendelenburg positioning (head below body) is for hospital pts, not PALS, but reverse Trendelenburg is the "tilt" feature, basically, and is very valuable for everything from using a male urinal to pressure relief and breathing more easily.

There is no need to code the bed of your dreams (any doc should have access to a billing service, though) if the goal is to submit codes that will be approved. That will generally be a standard hospital bed, with you paying the difference. You said you have a DME willing to bill for that. The PA process for HME -- well, you could be old and gray. Not saying not to try. You can order the bed and negotiate for reimbursement ex post facto.

Or look online and pay cash -- it's often cheaper, all told. Or get the bed from a DME outside your region (there should be national providers in-network depending on your plan?) They can ship, if needed.

If Medicare denies your bed claim, Medicaid might cover it -- DK NY rules. But likely, in any insurance scenario, you will pay for the difference between a more basic model and what you want. It actually is not all that much considering how many hours you are in bed.

 

[Doing My Best]

Steve, congratulations on finding and getting that bed, what a saga. We were able to get a Freedom Bed (made by ProBed) a couple of months ago via "matchmaking" by our local ALSA, given directly from another family to us. It's been fantastic - it rotates side to side in addition to up, down, Trendelenbug/reverse, and the usual head/foot lifts. It didn't cost us anything but the head and foot lifts simply stopped working last week, so we are about to find out what repairs cost, several hundred dollars most likely. No matter, still infinitely grateful to have it. Luckily PALS can sleep in his PWC until we get the bed fixed, though he's not very happy about it.

 

[Nikki J]

My sister got the freedom bed after a lot of pressure on the insurance. She hated it and never used it. I do believe they didn’t try very hard to work through the issues and it could have been helpful. It was donated and I hope the next owner got a lot of use from it. a comfortable sleeping arrangement is so important!

 

[MupstateNY]

1. Medicaid won't pay unless Medicare covered.
2. Out of state will cover Medicare but not Medicaid. But I must get the prior auth in place first or no Medicare.
3. It has been explained to me that it would be illegal for a DME vendor to take money from me given my Medicaid coverage.

The key is to get that prior auth for the right sort of bed! Thanks all, for the encouragement. I'll try to wade through the guidance myself.

 

[lgelb]

A DME vendor cannot take money technically from a Medicaid pt, yes, but if you say you are a cash patient and do not provide insurance details..there is a similar scenario when insured patients want to pay a provider cash, which is technically prohibited by payor contracts, but it usually works out. That is why I pointed out that cash can be king, but I did mix the two scenarios, sorry. Moreover, you would never be providing insurance information to a Web site that is cash-only -- not processing insurance in any event. It's a DADT kind of thing.

 

[MupstateNY]

What an interesting idea, thanks, now I get it. What do I say if they ask for my ins. info? "I prefer to pay cash out of pocket"?

 

[lgelb]

"I am paying out of pocket."
"This is a cash purchase."

The key is a tone that brooks no debate. If you provide any other details, they will shut down. Then they decide if they want the business or not. Of course, if you are talking with a DME off line, you should also ask for "the cash price."

But again, Web sites don't care. I see one called Home Care Hospital Beds that has a lot of choices, including the ones that go low. (Obviously, I would vet them -- that is just a random example.) Rehabmart is a reputable dealer from whom I have purchased, whose pricing can be wonky but I see a reasonable Joerns bed there right now that looks similar to what ours was.

These days, a lot of the beds with standard/reverse Trendelenburg are called "five function beds" in the headline but others, you have to read the description.

Of course, if you buy a la carte, you also need to buy a mattress. Fortunately, they are a lot cheaper.

 

[MupstateNY]

lgelb, i thought reverse trendelenberg was necessary. i have totally struck out in getting from medicare. how should i arrange bed parts?

 

[lgelb]

I doubt you would get that feature covered by Medicare. I thought you were trying to get it from NY Medicaid or for cash.

It is not essential in the sense that not everyone has it. It would be nice to have.

 

[MupstateNY]

what is the ideal arrangement of head and knee elevation for use of female urinal?

 

[lgelb]

I think that's going to depend a bit on the urinal -- and you. But typically they can work either sitting up (in which case you'd raise the legs first to avoid slipping, then the head portion of the bed, then straighten the leg portion to be more flat) or lying down.

Three of the better-rated ones seem to be Pibella (tube attached to reusable bag), Aqua Eve Female Urinal (all in one), and the Female version of the UriBag (Larry used the male version).

 

[MupstateNY]

i have pretty much talked myself into buying a fully electric bed with reverse trendelenberg out of pocket. can someone help me choose one? it is rather overwhelming. thanks.

 

[lgelb]

This may sound backward, but start from the vendor you want to use. On Amazon, there is a Point A bed ("5 function" model number PAM-5) that would be fine. But vendors carry different lines. I am sure there are cheaper options. Brands to look at include Invacare. You want a Linak motor.

Some vendors have payment plans, some offer indoor delivery and some do not.

Do you need inside delivery/unboxing/setup? That could limit shipper choice, or you could hire someone to put it together on your end -- Taskrabbit type/handyperson thing.

Look at in stock (even though certain options may extend lead times) vs. back order, which might take forever.

Do you need a battery backup (in an area where the power goes out a lot)? [Reminder to all: get on/verify you are on your power company's emergency restoration list -- it's hurricane season.]

I believe you are petite, so a 36-38 x76-80" mattress would do?

Some people want railings, some do not. Some want headboard/footboard, some do not (we were in latter camp, easier to reach PALS). If you will be next to another bed (2 inches between for movement, better a couple more so someone can actually stand on side for eye drops, etc.), you only need one set of side rails.

SpinLife (look at PrimeCare model with staff control option, cheaper than Amazon's bed, Drive is low-end but probably fine), Rehabmart (look at UltraCare XT Four Section Hospital Bed Frame, buy mattress separately) , medicaleshop are all reputable vendors with beds.