Medicare and Electric Wheelchair

[1smurf]

Medicare has denied my electric wheelchair twice now, started this process last October.

 

[Nikki J]

Is it your ALS clinic ordering it? Usually they know how to write it up

 

[Clearwater AL]

1smurf, It might be more helpful for us if you would post some
intro info. When did it start, who or where you were diagnosed
and did or are you considering a second opinion.

Maybe with Medicare there has to be confirmed complete loss
of limb. That's where some more info would help us.

 

[KimT]

I found the provider of the PWC to be a great help. My doctor ordered a PT evaluation and the PT, along with the PWC provider, worked out all the details. It was when I had a sprained ankle so I wasn't able to walk....only hop. It was my good leg and the ankle healed so I didn't need the PWC when it arrived. I would need it now if I had to walk more than 1/4 mile.

I also did it all locally. Didn't even use the clinic since it was nearly 3 hours away and I didn't want to go there just for an evaluation that could be done locally. So my pain management neuro ordered the evaluation. All he did was write an Rx for a power wheelchair with a code of ALS and fibromyalgia (that second code gave me more options for padded arms and seats.)

Sorry you're going through this. What reason did Medicare give you?

 

[Mary2]

Sorry your going through this 1Smurf. Has Medicare already paid for a wheelchair for you? I know they will only purchase so many wheel chairs within a certain time frame. Welcome to the Forum.

 

[1smurf]

I had signs of a drop foot in 2016 to 2017, first EMG fall of 2018, second opinion 2021. Working with National Seating and Mobility for electric chair. Legs are gone, and arms are following.
Taking the 3 R's, Riluzole, Radicava, and Relyvrio.
This is my first chair with Medicare, first denial was because I didn't meet the criteria, second the paperwork needs to be adjusted, or at least that's what I make of it. With ALS a lot can change in 5 to 6 months.

 

[Tomswife]

I would think NSM knows how to write up the order so that it gets paid.

This info below is not recent but you may see something here that is a clue into the reason for rejection.

Medicarerights dot org

Search for article:

How do I get Medicare to cover a power wheelchair?​

 

[Tomswife]

Also. Another older article that may be helpful.

How to Minimize/Avoid Denials:

Understand which items will be subject to prior authorization.

The list is located at
federalregister dot gov

Ensure sufficient documentation. Evidence must include information that the item complies with all applicable Medicare coverage, coding, and payment rules. The paperwork must be error-free, legible, and complete. Whenever possible, have the prior authorization request reviewed by multiple people before submitting it.
Monitor the maximum prior authorization timeframes established by the rule. The timeframes are ten business days for initial review, twenty business days for re-submissions. There are unlimited re-submissions, but, unfortunately, no appeal rights.
Know that there is a process for an expedited request for prior authorization. Documentation must be submitted with the request that indicates how the life or health of the beneficiary will be seriously jeopardized without an expedited review.

Source is medicare advocacy dot org

 

[daydreaming]

I went thru this process a couple of years ago. I spent months going to doctors, PT filling out paperwork to ultimately find out they would approve the device if I used it in the home.

I gave up and did a search on Craigslist and bought a used one from a family who parent had gotten it and used it. That person sadly passed away. I got lucky in that he had purchased a new battery.

No long afterward I took a flight with an airline. They destroyed it. The airline purchased a brand new one for me at no cost!