Wheelchair & van advice?

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KimT

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If you have Medicare and Supplement F or G, you can get everything except the standing feature 100% paid. Some people didn't get the seat elevation paid but those of us who did got our doctors to write the elevator function was medically necessary and took that letter to the providers. Permobil ended up paying for my seat elevation function. I didn't get the standing function and, if you want it, you'll have to pay for it.

I got my chair very early because I sprained my ankle and nobody thought it would heal. They brought both the Quantum and Permobil to my home and I tested both. Ended up liking the Permobil better because it didn't jerk me around. After I knew I wanted the Permobil, I called Permobil and asked the representative to come over with all her seat options. My doctor wrote on my letter that I had fibromyalgia and needed extra padding on the armrests, etc. I got to test about a half dozen different seats and she let me take my time. She also brought a couple of arm padding samples.

If you have Medicare with private insurance secondary, you may be surprised at what they'll pay for. It just depends on your insurance. I know of at least one PALS who got the stand up function paid for by his private insurance, even though Medicare doesn't cover it.

One caveat: Beware of provider markups and incentives to sell one model or make over another. I had that trouble with my provider. They were dead set on my getting a Quantum and I didn't like it. I did some investigation and found out that there were dealer incentives on the Quantum and their profit margin would be higher.

If you buy a van, same deal. Don't even consider paying close to sticker.
 

lgelb

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James, just making sure we are not confusing the "stand" feature (which is more expensive and less likely reimbursed) with the "seat elevator" feature that is a fourth of that and that many of us have gotten reimbursed or paid for. I think we are all pretty clear that the latter is worth it.
 

Jamesgol

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Hi Laurie,
I am a total neophyte. I have so much I need to learn. I already know I must have a seat elevator. Based on what I have read, it would be nice to have the ability to stand vertically as well. I'm not sure how well that would work for a PALS who can't use their legs or, perhaps, worse as I progress. I was told by Numotion it would add $12,000 to my cost. I really wonder if it's worth it.

Thx
James
 

swalker

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I have 4 wheelchairs. All have the seat elevate function. One has the standing function.

For the standing function, we attach a padded bar across my shins and another padded bar across my torso. My wheelchair then goes through one of two different sets of motions to put me into a standing position, depending on which button I push.

I like having both sets of motions and use them at different times.

The standing function has advantages:
1. Therapeutic - it really helps stretch my legs out, changes my blood flow, and just makes me feel good physically in ways that I can't quite put into words.
2. Emotional - it is nice to be standing tall again without having to use a lot of effort.
I am 6' 3" and the wheelchair adds a couple of inches to that. So, when I am standing I am above eye level for most folks. That has not caused me any issues.

Is it worth it? It is for me. But, I am a slow progressor. Five years in, I can still stand briefly on my own and walk short distances. But, I cannot stand for long unless I use the standing feature of my wheelchair. I can't say how useful the standing feature will be when I don't have any strength left in my legs. I think it would work fine, but that is just speculation on my part.

In my case, Insurance paid for the standing feature in my first wheelchair. We are currently going back and forth with insurance to see if they will cover it for the F5 I am trying to get.

I am pretty sure I would not pay $12,000 out of pocket for the standing feature. That is easy for me to say because I already have a standing wheelchair (even though it is more than a bit unreliable). That wheelchair will still be available for me to use when I get the F5 (with or without the standing function).

I paid out of pocket for the seat elevate feature on my first wheelchair and will do so again (if necessary) on the F5 I am trying to get. My seat elevate was less than $2,000.

By now you know that power wheelchairs are heavy. My first wheelchair (Permobil C500s VS) was 350 pounds. I was stunned to find out that the Permobil F5 VS I am trying to get weights 428 pounds. My van lift has a capacity of 600 pounds and feels like it is already at capacity with 525 pounds (the C500s VS and me).

Steve
 

lgelb

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The standing option is relatively new in mainstream chairs and most PALS don't have it. As the muscles weaken and joints under stress are at risk, the body's ability to support standing even bound into a chair is problematic. For some conditions, it can be very helpful to have a standing feature, but ALS generally isn't one.

But if your chair-to-be has an anterior tilt option (where the seat tilts forward as well as back), I would go for that -- it can be helpful for relieving pressure and could also help with standing/transfers/reaching for objects in the shorter term. With the right justification, insurance may cover it and the Gleason Foundation is also working with Permobil to fund seat elevators, attendant controls and 30 degrees of anterior tilt for PALS in need.
 

Ken15

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Permobil ended up paying for my seat elevation function. /QUOTE]

We are in the process of ordering a Permobil M3 for my PALS and the provider is indicating that Medicare will not pay for this option.

Per your advice, we have contacted the doctor and asked that it be declared medically necessary.

As a back up, could you share how Permobil was persuaded to pay for this option?

Thanks,
Ken
 

lgelb

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Permobil has set aside funds through its foundation for these requests. If you haven't already met with your area Permobil rep, I've attached the application that both you and the DME can complete, with medical documentation.

It's a more formal process than it used to be.
 

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