Ordering Wheelchair

[KimT]

The guy from Mobility Works called tonight. After my PT eval. and his measurements, he informed me that I'd be getting a Permobile M-300. He said I had to pay for the lift function up front and then try to get reimbursed from Medicare. He didn't order a ROHO seat and I told him I needed one. He said he hadn't talked with the PT and I told him I had a doctor's request for that type of seat because of fibromyalgia and lots of pain. He said he could add it to the order.

He didn't go over any of the options with me so I told him I'd call him back after I looked at Permobile's site and that particular model.

Any suggestions? I'm still stewing over the fact that Medicare doesn't pay for seat elevation.....like it's some form of luxury. My letter is two pages long justifying why I need it and how it helps me with ADL. The PT actually wanted a copy so I'm sure much of what is in it will be incorporated into her report.

I do think it's pretty strange that the Mobility Works guy didn't contact the PT before trying to place the order?????

 

[GregK]

Kim, I think someone else here went thru this same effort recently...

Try Search, I'll poke around too.

 

[Buckhorn]

Hi Kim. We are going to a wheelchair clinic tomorrow. I am very interested in the Permobil C300 as well; that is the w/c I am going to lobby for. My understanding is the same - that Medicare does not pay for the chair lift function in most situations. However, the PT who runs the clinic that we are going to said she has seen it go both ways ....... sometimes Medicare pays and sometimes they don't, and in her opinion it is really dependent upon the person reviewing the case and the mood they are in. Having worked in the medical field (LPTA) for > 30 years now, I have heard countless stories along the same line. I am asking for the lift funcion and I want it whether MC will pay or not. It will make our lives so much easier, and enable me to transfer my husband from the bed to chair with greater ease. A Hoyer (or other/generic) will not fit in our downstairs bedroom very easily.

I am personal friends/co-worker with the PT who runs the w/chair clinic, so if find out any keywords to put into an appeal, I will be sure to let you know. Having filled out many progress evals over the years for long term care / SNF's, I can tell you that use of the words such as maximizing SAFETY, independence, prevention of FALLS, prevention of INJURY, and allowing the person to remain in there own home SAFELY (yep, use that often) are key. Do NOT use the word "maintenance" anywhere, ever, when making an appeal to Medicare. They are not interested in maintenance & do NOT want to pay for it. You must appeal to their sense of how this will save the SYSTEM $$$ in the long run.

I am going to state something very cynical right now, so please indulge me. Medicare as a system really needs people with expensive, chronic illnesses to die and get it over with. Terrible to say that, but that is how I really feel. The system is over-taxed, way less money coming in than going out, fewer people in the work force to pay for the burgeoning amount of people on MC, so it really is a mess. They are not going to give out expensive equipment without whatever justification they see fit. I get it ........ I do know the system is overtaxed and it is an enormous burden on the young.

Hope you do get reimbursed for the lift function. I am planning on having to pay for it and deduct it on our taxes. We have way more than the 7.5% of total income of un-reimbursed, medically necessary expenses this year due to remodels, so I want the lift function, one way or another. Please let us all know how you make out, and for your sake, I hope it is paid for!

 

[patrick123]

When I got my Permobile three years ago Medicare would pay for the elevator. No amount of begging will get you one. I was lucky when got my chair Permobile just donated one elevator to several ALS chapters that how I got mine.
Patrick

 

[lgelb]

It is not unusual for the DME and PT not to coordinate well. Definitely get the ROHO seat and back cushion in your order.

He should submit the order w/ elevation and make your MA plan deny it if they want, which will also help you seek mfr or other funding.

Buckhorn -- the C300 is a front wheel drive chair, the M300 is mid wheel drive. Not sure which one you meant.

Kim, the M300 does not have anterior tilt, a feature we discussed earlier -- just a reminder if you were considering it.

 

[KimT]

Laurie,
I looked at the specs of the M300 Corpus 3G. It says it has dura core tile up to 50 degrees and power recline up to 175 degrees.

What other model should I consider? I'm pretty much stuck with Permobile.

 

[lgelb]

Do you mean tilt and recline? Those are different. (The "normal" tilt is backward. Anterior tilt is forward.)

There's nothing wrong w/ the M300 in many situations, just that you were talking as if you were interested in anterior tilt to help you stand (which you would likely have to self-fund and would require the F3 [or F5 if you wanted standing]). So just a reminder that the M300 is the previous generation. Still a good chair.

 

[swalker]

Kim, Here are some thoughts on wheelchairs. I also recommend you review my previous post on my experiences with wheelchairs. You can find that post by searching for "Things I have learned about a wheelchair". The thread should be near the bottom of the first page of the search results.

I am a fan of Permobil wheelchairs, but the M300 did not work for me. It was too tippy and was too small (I am 6' 3" and weigh 170).

My general advice is to pick out the wheelchair yourself, with the supervision of a qualified specialist. I would not accept a wheelchair someone picked for me. I would not accept a wheelchair I had not sat it in and driven for several hours.

When selecting a wheelchair, you have the choice of rear wheel drive, mid wheel drive, and front wheel drive. There are pros and cons to each. You can search the web for lots of information on this topic. Here is what I think about them.

Rear Wheel Drive

Pros

Can work in tighter spaces than the others
Many long-term wheelchair users wind up with a rear wheel drive
Pretty intuitive to learn to drive
​

Cons

Front casters can get stuck in things (think of crossing railroad tracks). Does not happen often, but it can happen
Not as good in outdoor rugged terrain.
​

Mid Wheel Drive

Pros

Has the tightest turning. You can pivot in place
Perhaps the easiest to learn to drive
​

Cons

I am not a fan of mid wheel drive, so I think just about everything else about them is a con.
The front and rear castors can lift the drive wheels off the ground on uneven terrain (and you will be crossing uneven terrain). This will strand you like an upside down turtle.
Front casters can wobble as you start off. Seems innocuous, until you are in a tight place, like going up a van's ramp. Then it is a major pain.
​

Front Wheel Drive

Pros

I think they are the best for outdoor use. The front drive wheels climb over small obstacles (but not things the height of curbs).
​

Cons

Perhaps the hardest to learn to drive (but, I learned it pretty quickly).
Take more space to turn
The tightest turning is going in reverse. I have to go into my house backwards to make the tight corner there. I find it natural now, but the first dozen times I did it it was "exciting".
​

When choosing a wheelchair, fitness for use is very important. If you are getting one primarily for indoor use, a rear-wheel drive model might be best. If you plan to get one for outdoor use, a front-wheel drive model might be a better choice. You will only find out by testing them.

You really get one shot at this, so it pays to put the effort into it to get it right. Medicare will only buy a wheelchair every 5 years (there are some special exceptions). So, the wheelchair you select is the wheelchair you will be living with.

Get all the options up front. Trying to get insurance/medicare to pay for them incrementally after the initial purchase is a major pain. Here are some things I got

1. Cup Holder - I don't use this
2. Thigh holders (I don't know what they are called but keep my legs from sliding sideways off the chair) - I can't live without these
3. Lateral thoracic supports - I can't live without these
4. Stealth headrest - The stock Permobil headrest does not provide enough support or adjustment options for me
5. Push handles - Surprisingly useful
6. Arm Holders (go on the sides of the armrest to help hold my arms in place) - I have not use these yet, but am about to start...highly recommended
7. Light kit (head and tail lights along with turn signals) - an essential. Insurance paid for these. They allow me to be safe when outdoors near and after dark. I use them a lot in parking lots making my way back to the van, as well as when crossing streets.
8. High speed motors - not just for fun. They allow me to cross streets more rapidly, which is safer. Crosswalks are a dangerous place
9. Seat elevate - I think this is an essential
10. Tilt - I use this regularly
11. Recline - I use this regularly
12. Leg Lift - I use this regularly
13. Standing Function - I use this from time to time, but will be using it more
14. Seat Belt - I always use this on one wheelchair, but not my primary permobil. I am about ready to install the belt on my primary wheelchair as I am having trouble staying back in the seat.
15. Tray - I don't use this yet, but will within the next year
16. Foam-filled tires - great for indoor use and ok for lots of outdoor use. Note that I am just about through my second pair of these. They only last about 700 miles of use (the way I use them)
17. Pneumatic outdoor tires - much better for rough terrain. These are my snow tires

Make sure it comes with MK brand batteries. In my experience, they are far and away the best. They will have the longest life and will hold a charge longer than others. They are more expensive, but well worth it. Insurance paid for mine.

The wheelchair must be carefully adjusted to your body. My wheelchair provider did an amazing job on this, but I spent several weeks fine tuning the adjustment.

My primary wheelchair is a Permobil C500s VS. If something were to happen to it, I would replace it with the exact same model. Permobil has replaced this in their lineup with the F5 Corpus 3G VS. I also have a C500 Corpus 3G and I don't like the Corpus 3G seat as well as the VS seat. But, you might find the Corpus 3G to be better (many people do).

Good luck with your decision and let me know of any questions you have.

Steve

 

[lgelb]

Hi, Steve/Kim -- I don't think you 2 have the same lifestyle, so I would consider how therapists make the recommendation. Here is a link to a presentation/cheat sheet by one I know personally. Steve, remember that chairs come in different sizes (seat width/depth; back height are 3 of the dimensions that matter most). I am willing to bet you did not try the right size because demos tend to be smaller sizes.

I agree you should always try the chair if at all possible. Note that not all the options Steve got will be covered by all plans under all circumstances. Justification is key, but not the only variable.

 

[swalker]

Laurie, as usual you are right and your insights on this are greatly appreciated.

I agree that Kim and I likely have very different lifestyles, resulting in the need for different chairs for the 2 of us. What Kim selects could very well be different from what I would select.

Kim, pay close attention to that. If you have followed some of my threads, you will note that I am anything but a typical wheelchair user.

I was very fortunate to have the opportunity to try a wide variety of wheelchairs (and scooters) before making my selection. Fortunately, NuMotion (the DME provider I used) had many wheelchairs to demo with seats configured for my size. So, my observations are based on using properly sized wheelchairs. Of course they were not precisely adjusted to me, but the seat length and width as well as the back height and width were appropriate for me.

My specific comments on the Permobil M300 were that it was too tippy (really, I thought it was dangerously unstable) for my anticipated style of use. But, remember, I am a very aggressive user. I am always trying to figure out how to get the tires to skid in a turn Also, the M300 could not be adjusted to accommodate my leg length.

Many people have and love the M300. It is a wonderful wheelchair. But, before anyone decides on it, it is worth considering its limitations for their anticipated use and to review other options in the market.

I was also extremely fortunate to get a wheelchair through very good private insurance rather than medicare. With the help of my DME provider (NuMotion), we were able to get insurance to pay for everything but the cup holder and seat elevate function. NuMotion worked with me on those. I would not expect Medicare to pay for many of the options on my wheelchair.

Steve

 

[lgelb]

I agree that for someone w/ your lifestyle, Steve, a typical mid-wheel could be tippy. And for anyone, before you take on a crack, rut or slope, you should know how your chair drives and change your lateral angle of approach and speed as needed for safety.

 

[Buckhorn]

My husband and I recently saw a C300 at an MDA "Muscle Summit" in Allentown, PA. It was owned/operated by a young man, who was really keen on this powerchair. He had a friend take the front caster wheels off because he said they "just got in the way" and he claimed it did NOT undermine the safety at all (......"I couldn't flip it if I tried" was his comment). Not saying I agree with that assessment at all, since I know better; all W/C's can flip, especially on lateral slants or when approaching a lateral change in terrain. Anyway, we also saw, & Dave test drove either an S3 or S5 Corpus that a dealer had on site; not sure which one it was.

We decided that a FWD chair would be the best for our purposes. We have a stone driveway and Dave will want to operate it outdoors sometimes. To get from the bottom of the ramp to our car requires that we go across at least 10 - 12 foot of driveway stone. FWD powerchairs operate outdoors on slightly uneven surfaces better and can go over small obstacles as Steve states. Mid-wheel are prone to "hang-ups", also commented on by Steve. I have personally tried out many types of powerchairs over the years, and spent many hours helping train patients how to operate them. I have recently tried out several companies/models we had on loan in rehab. I don't think you have to feel you are "stuck" with Permobil Kim. I think they produce a superior product and seem to be very innovative.

We presently have 2, RWD powerchairs at home (one a loaner from a family member and another temporary use, lightweight hybrid model (EZ Lite Cruiser deluxe) which we bought out of pocket. I am not a fan of how these handle on our stone driveway. Both are difficult to nearly impossible to drive downhill on the loose stone in our driveway. The front caster wheels become really wonky, going this way and that and getting easily turned off center by the stones and uneven surfaces. So, I second Steve's advice that if you intend to do any outdoor travels at all, RWD and mid-wheel drive will each pose challenges. As far as I know, there is no "perfect" powerchair available ....... or at least none that insurance will pay for. They all have their pluses/minuses and each person has to figure out what is best suited to their needs.

This is what I have learned about the C500. The C500 was phased out in the Summer of 2015. It has been replaced by the F3 Corpus & F5 Corpus. We will be receiving the F3 because it has a smaller turning radius and slightly smaller footprint. The F5 has higher top speed, longer driving range/distance and a 14" lift vs. 12" on the F3. The F3 has a 26.5" turning radius vs. 30" for the F5. That makes the turning radius of the F3 comparable to the highly touted, tight turning radius' of many mid-wheel drive models. Both models have anterior & posterior tilt, recline and leg elevation.

The F3 Corpus also has a USB port and bluetooth capabilities, and the joystick control also has a keypad control that is closer to the user so that if you tilt or recline back too far you can reach the touchpad easier ......... or so I understand? It was a lot to absorb! As you can tell, I'm pretty biased toward's the Permobil F3/F5's for our purposes.

Regarding the cushion, a molded gel cushion was recommended. I need to get back to them tomorrow to get more details. Truthfully I think I zoned out during that part. I am very familiar with the Roho and it is considered the Cadillac of wheelchair cushions for someone who has trouble repositioning, cannot weight shift &/or has diminished or missing sensation. There are some down sides to the Roho though (thigh & hip alignment) so I am myself not a fan for my husband at this time. I am interested in the Corpus Ergo air cushion, although it is new to me. Does anyone know anything about this cushion? It appears to be a hybrid, offering the positive aspects of proper sitting, hip and and thigh alignment with the added benefits of the superior pressure relief afforded by the Roho. I need to find time to research it a bit before they order me the gel cushion! I also need to call and discuss the joystick options; there are dome shaped and U shaped handles that may be more appropriate for my husband in the very near future, as he is rapidly losing fine motor control of his hands.

We attended a "wheelchair clinic" today that is run by a DME salesman with many years experience with powerchairs and a PT who also has 20 years experience. She has been working these clinics for almost 10 years. I would highly recommend the clinic type experience operated jointly by both professionals if possible. In our case, they were very thorough and discussed options, asked us quite a few questions regarding our intended uses, etc. Plus, they were very encouraging that we stood a very good chance of having the lift option paid for by either Medicare or our secondary insurance.

Steve makes a great case for trying out several makes/models of power chairs and testing them out thoroughly if possible. However, this is not really an option in our rural area, without driving quite a distance to a large DME equipment dealer with many makes and models in stock.

Steve, thank you for your very detailed posts regarding wheelchairs (I had read your "What I have learned ....." post previously and it is extremely thorough and helpful. Kim, best of luck with your decision and ultimate choice.

 

[swalker]

I agree that for someone w/ your lifestyle, Steve, a typical mid-wheel could be tippy. And for anyone, before you take on a crack, rut or slope, you should know how your chair drives and change your lateral angle of approach and speed as needed for safety.

Laurie, this is a really good suggestion. I am an adventurous person and certainly drive my wheelchair in ways many people would not consider. But, I did not start off that way. I spent months learning the characteristics of my wheelchair before I started going wild.

Even with that caution, I still had to make a trip to the doctors to get my leg xrayed after one mishap with the wheelchair.

So, before hopping in a wheelchair and going crazy, remember that they are extremely heavy, and very powerful tools. They can be used to great effect or abused with disastrous consequences.

One just needs to look at the drywall in my house for proof.

Steve

 

[affected]

Fantastic thread, so much information from everyone throwing in their bit

 

[azgirl]

Re: Ordering Wheelchai

I am for the most part very happy with my Permobil m300. For me The Mid wheel drive is Great for maneuvering in tight places, especially entry to my van. It is not good at all forand loose gravel or Rougher terrain. This would be a very bad choice or Steve! I have gotten stuck a few times, but overall it is a very good choice for me.

The roho seat Cushion I could not do without.

If you have to pay out of pocket for the seat elevation, you should be able to bargain with the company for a lower price.