Post Clinic Question

[JohnnyMags]

OK we are a day after our clinic visit and I have to ask this first. My wife is in dire need of a power lift recliner. I asked about that at the clinic but they kind of brushed that aside. Who do I contact for that? We have Medicare with an Aetna supplement. I heard about medicare only paying for the motors but I don't even know how to apply for that. If there are other options which would pay for more I'd like to hear about that.
I also asked about a custom PWC because I read here you need to get the ball rolling 3 or 4 months before needing it yet they told us at the clinic it's too soon. How would they know that?

 

[Nikki J]

I got my recliner from a local dme store. They needed a prescription from the doctor and submitted it iirc. And yes they only paid part of it. I do know people who had their pwc refused because they were not advanced enough The clinic has experience in what they have to document and apparently she does not yet meet criteria. Sometimes they can stretch things a bit but of course they can not lie. I was just reading about an np who was convicted for medicare fraud. She might get 50 years ( this was outright fraud)

 

[lgelb]

Re the lift chair, here is the Medicare info -- it's not a lot of $ for reimbursement, unfortunately -- one site estimates $300. For starters, to get that, you would need to use a Medicare-approved supplier.

Re the PWC, it's true that there's lead time, which will probably only get worse given the tariffs for the parts, etc. But specific criteria are required and she may not meet them yet. In particular, the requirement that a cane or walker no longer meet her needs may be coming into play.

Here are the requirements for documentation:

https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/DMEPOS/Downloads/DMEPOS_PA_Documentation_Checklist_2017-03-24.pdf

 

[jamieinaz]

Hi Johnny, I'm in AZ, and fortunate to have an outstanding ALS association to back me up. At a clinic about 4 years ago, I mentioned it was oncreasingly difficulty getting off the couch. I had to slide down to floor, get on all fours, and power myself up the couch with the help of one useful leg. The ALS rep ordered a brand new lift chair from the manufacturer and it arrived at my door a week later. It was not my dream chair (I've seen it retail for $250), but it has been functional. Maybe this is an option?

About the PWC, my ALS clinic PT is the "gatekeeper" for the request going to insurance. Having read enough posts, I knew I didn't want to wait too late to get it, so when the next clinic came and I had enough anecdotal and physical (scars/bruises) evidence of falls/near falls, I backed off a little during my strength assessment. Not cheating, just not giving my usual 110%.

Sorry for what you are going through. Best advice I have is not to have too many things on your plate at once by practicing compartmentalization. Don't worry about everything all the time. If something is worrying you, make a plan, deal with it, and enjoy the calmness when you can. (The binder idea is an excellent idea, but don't "overprocess." It also goes without saying that you need to take care of yourself so you can sustain through this journey. ALS in AZ has respite funds of $400/2x yr, to cover help coming in and giving her a break. Unfortunately for me, my wife's idea of recharging is heading off somewhere alone with a backpack for 2 months. (She pre-cooks/freezes meals before she goes).

Thanks for letting me ramble...I'm procrastinating from chores!!!! Hope you found something here you can use.

Jamie

 

[JohnnyMags]

You say not to have too much on my plate but I feel like I need 5 plates. I have so much to either do, worry about, ask about, research I am trying so hard but I seem to be getting nowhere