Insurance/Medicare Coverage for Shower-Commode Chair

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Jay Q

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Joined
Aug 11, 2018
Messages
16
Reason
PALS
Diagnosis
08/2016
Country
US
State
LA
City
Metairie
I’m 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, I’m wondering what others’ experiences have been with insurance coverage for a shower/commode chair.

The lady at my insurance company said personal hygiene items aren’t covered as they don’t 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 I’d 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
 

Doglady

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Joined
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Messages
218
Reason
PALS
Diagnosis
04/2018
Country
US
State
MN
City
Minneapolis
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.
 

lgelb

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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.
 

KateEmerson

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Messages
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Lost a loved one
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09/2013
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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
 

KimT

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You should also apply for a grant from your local ALSA chapter and ALS Guardian Angels.
 

blitzc

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Apr 20, 2018
Messages
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Reason
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Diagnosis
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OH
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Massillon
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.
Cathy
 
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