wheelchairs and Medicare

[Lynne]

Hi. Sorry if this is the wrong forum but I need some help. I need a lighter wt. chair. I'm in a Quickie 2hp. I thought I'd go to a seating clinic 'cause it would allow me to get something better in the cushion area as well. Well, a PT there (they put me thru to one on the phone) told me that I should wait until I had money in my pocket before coming because Medicare wouldn't put me in anything lighter than what I have, and that they probably wouldn't have even put me in THIS chair 5+ yrs ago. (I worked and had other ins. at the time) Does anyone know more about this? I don't have a chunk of "out of pocket" money. I'm an incomplete C6-7, and fold/load my chair behind the driver's seat. I'm wanting to explore lighter wt. folding and rigids in order to ease my shoulders in loading and rolling. I'm not sure I'd have the trunk control or arm strength to load a rigid but I thought at a seating clinic I'd have the opportunity to try different things. I've only called Shepherd. I did rehab at Warm Springs, but haven't called them because I heard they may not do pressure mapping which I think I could benefit from and they don't carry as many kinds of chairs. Sorry to be rambling, but I sure could use some more knowledge about this Medicare stuff. I have CHAMPUS/TRICARE as secondary ins., but that wouldn't ADD to what I could do.....right? Thanks in advance for any and all advice! Lynne

[SCI-Nurse]

Medicare rarely will cover ultralight chairs, but any Medicare decision can be appealed with a letter of medical justification. It can take a fight, and you still may not win. Check out SpinLife.com as you can see those manual chairs there that are are Medicare approved. Best to work closely with an experienced PT and a local vendor they refer you to on this issue.

(KLD)

[OLDSAILOR55]

I noticed you have Tricare as a secondary insurance, so I am guessing you are a veteran. If so check with the VA in your area, as a SCI patient you might be able to get a lighter weight wheelchair.

Mike

[SCI-Nurse]

Tricare is an insurance for both active duty as well as military dependants and retired military and their family. It pays for care at non-military or military clinics and hospitals, but not the VA (which is non-military, and only for veterans).

Veteran's dependents are not eligible for care at VA hospitals.

(KLD)

[Lynne]

Thanks KLD and Mike for your replys! I'll check out SpinLife. I'm the dependant of a retired military officer, so the VA is not an option. Do you know if my ins. would cover going to the seating clinic to get an evaluation and a new cushion, and while there LOOK at chairs in order to see what I would want WHEN I could afford it? Actually I could benefit greatly just by having a backup chair so that when this thing is in the shop I don't have to struggle with the Breezy they put me in as a loaner. I live in rural SW GA and my options for investigating types of chairs are quite limited. I got this chair through PT from a vender 1hr away who ordered it after sending someone up here to look at me. He decided what I should have and that was fine 'cause I didn't know anything about chairs then. It's been a good chair for me to this point. Any more thoughts? Do venders allow one to pay in installments? http://sci.rutgers.edu/forum/images/smilies/smile.gif Thanks, Lynne