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Insurance/Medicare Coverage for Shower-Commode Chair

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Jay Q

New member
Joined
Aug 11, 2018
Messages
6
Reason
PALS
Diagnosis
08/2016
Country
US
State
Louisiana
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

Active member
Joined
Aug 6, 2018
Messages
71
Reason
PALS
Diagnosis
04/2018
Country
US
State
Minnesota
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

Forum Supporter
Moderator
Joined
Nov 5, 2009
Messages
7,360
Reason
Lost a loved one
Diagnosis
09/2009
Country
US
State
WA
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

Distinguished member
Joined
Apr 23, 2016
Messages
433
Reason
Lost a loved one
Diagnosis
09/2013
Country
US
State
MA
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

Forum Supporter
Extremely helpful member
Joined
Nov 18, 2014
Messages
3,254
Reason
PALS
Diagnosis
08/2015
Country
US
State
South
You should also apply for a grant from your local ALSA chapter and ALS Guardian Angels.
 

blitzc

Distinguished member
Joined
Apr 20, 2018
Messages
116
Reason
PALS
Diagnosis
01/2018
Country
US
State
Ohio
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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