Medicare says shower is a luxury.

[Chincoteaguer]

Just learned from our ALS clinic that a shower wheel chair is not covered by Medicare.

My supplemental insurance only covers items that Medicare covers.

Rule says shower chair is a luxury item thus not covered.

Both Medicaid and many private insurance companies cover the shower chair.

Can't complain since Medicare is covering almost everything. Just a little disappointed.

Thinking of buying a Shower Buddy which has been mentioned on this forum.

Any feedback would be appreciated.

Ernie

 

[azgirl]

I got a nice tilting shower chair from the local ALSA

 

[lgelb]

What kind of shower stall are we talking about? Threshold, level, width of entry, how big?

 

[Chincoteaguer]

Laurie;

Roll in shower, no threshold. 72 inch opening. Grab bars. Box seat.

Plenty of external space.

E.

 

[Diane H]

Talk to someone at a medical supply company about getting a bedside commode chair with wheels, padded open commode seat, footrests, some ability to recline, and that can be rigged up by a handyman with a headrest -- and that can still be filed as a commode chair, not a shower chair. A medical supplier will know the Medicare rules and if there is something available that doesn't have to be filed as a shower chair.

 

[whereswaldo]

We were told that, generally speaking, once you go through the bathroom door, insurance does not pay for to much. So we haven't tried to purchase, but have borrowed from an ALSA loan closet.

 

[lgelb]

Diane,
I believe E0240 is now categorically non-covered by Medicare, so once you go past bedside commode, that strategy may not work.

Best,
Laurie

 

[KimT]

EZ Life has some very aluminum tilt shower/commode chairs with headrests.

 

[Lkaibel]

A simple Commode/shower chair can be had for a few hundred bucks. We got ours however from the ALS Loaner closet along with:

An iPad
A commode
A loaner power chair
A couple of walkers
A portable shower
A hospital bed
A hospital bed table
An iPad stand
Alexa installed at home by Geek Squad. Now have “smart home”, only had to buy new lock for front door.

Try the loaner closet for sure.

 

[Diane H]

Lori, you must not have a devious bone in your body! I certainly do but prefer to call it "creativity". The whole point is not to go past "commode". Get a nice one, add a headrest and even the wheels yourself, and file it as a bedside commode without using the word "shower". That is the poor man's work around.

In reality, Medicare is really harsh about commodes. Commodes are only covered by Medicare if the patient is confined to bed or room. The term "room confined" means that the patient's condition is such that leaving the room is medically contraindicated. The accessibility of bathroom facilities generally would not be a factor in this determination. However, confinement of a patient to his home in a case where there are no toilet facilities in the home may be equated to room confinement. Moreover, payment may also be made if a patient's medical condition confines him to a floor of his home and there is no bathroom located on that floor.

 

[lgelb]

Diane,

Yes, you stated fully the Medicare requirements for a bedside commode, but that code's reimbursement is never going to come close to the cost of a shower/commode chair, as you also noted.

Devious? Me? Yes. But also realistic. A DME is not going to supply a "real" multimodal chair for a bedside commode payment. So you are going to fund it anyway, so might as well go on line and get what you want, without the inflated Medicare pricing. Or, as you say, get crafty. Just don't expect "real" reimbursement..

 

[Chincoteaguer]

Thank you all for your input.

I have emailed our local ALS folks and asked for a shower chair loaner.

We will be using our new roll in shower today for the first time and because my PALS has some use of her legs we think we can use the conventional stationary shower chair. At least for a while.

If the loaner works that would be great otherwise I will purchase a new one.

Ernie

 

[Diane H]

Inflated Medicare pricing... So true! I have found I that my 80% co-copay ends up being the same or more than what I pay when buying suction catheters, gloves, and gauze online. I am generally very happy with Medicare and would like to see Medicare for all but am furious when I see the jacked up prices of Medicare providers.

 

[Chincoteaguer]

Inflated Medicare pricing?

I assume this means that vendors jack up their prices when funding comes through Medicare. Odd to think that Medicare sets prices.

 

[lgelb]

The ship has sailed. MSRPs have nothing to do with Medicare's allowable amount for a given DME or HME code. The latter is fixed. But Medicare's reimbursement is not paid to manufacturers, but rather to whoever actually orders the equipment.

Whoever orders the equipment for a patient is typically paying half or less of the MSRP to the manufacturer. So MSRPs are kept high because that benefits the manufacturer and purchaser with (a decreasing number of) Medicaid and private payors, and with (what is increasingly) cash pay. Meanwhile, Medicare reimbursement for HME/DME is only going down, with the new competitive bidding programs essentially a "how low can you go" exercise.

So, though non-Medicare payors somewhat offset the money that they (DMEs, clinics) are losing on Medicare, it's not enough, decreasing their enthusiasm for any but the cheapest options in a given code family. That is why P/CALS should be aware of their options; not every DME will spontaneously offer or order what is best.