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Thread: Medicare/Medicaid; New Chair ?

  1. #1

    Medicare/Medicaid; New Chair ?

    Hi,,,,,,,
    I have 2 questions.


    I have Medicare and Medicaid; my DME's are billed in that order. All my DME [ power chair/manual chair/bed. ] has to last 5 years [their estimated life spand of the items.] before they will pay for a new one.

    Is it possible for Care/Caid to pay for a new chair even if is still functional after the 5 year mark ?
    Or do you have to wait until the equipment is not operable, have nothing and then have to go through the process for replacement.

    ==================================================

    I had a manual chair for many yrs then I got a powerchair about 5 yrs ago. My 8 yr old manual is barely useable. I do ''need'' both a manual and a power chair; not all buildings/situations are accessable or practical for a power chair.

    Do any of you have Medicare/Medicaid; and have both a power and manual chair paid for by them ?

    Thank you,,,,,,,
    Freej
    Last edited by FREEJ; 03-19-2009 at 01:43 PM.

  2. #2
    Hi,,,,

    I got the answer to my first question [above]. Although my powerchair is approaching 5 yrs old, it's in good shape so I'm OK.



    Regarding my second question; ''LiL Help, Please.''

    Is there anyone in the situation where they primarily use a powerchair; But they also use/need a manual chair. For places that are not powerchair accessible, or efficient for a p/c.

    Is anyone in this situation ? Did they get Medicare/Medicaid to cover a ''manual'' chair [even though you have a powerchair] ?

    Thanks,
    Freej

    ****Should I post this in a different forum for better feedback,,,,,,,

  3. #3
    M/M are getting getting even more ridiculous because of the cost squeeze. You can probably get a new power chair after 5 years as long as you can get a prescription indicating you need it. I would never ask them to pay for a manual chair because they will conclude you do not need a power chair despite your valid reason for wanting both types. You should try spreading the word or advertising your need in your community. There are often people who have an unused chair and are looking for a person in need to give it to. I have done that with one of my old chairs, which still had a few years left in it, espcially if uesed only for a backup.

  4. #4
    Senior Member DaleB's Avatar
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    I agree with 55, you could likely find one locally. I've given away 2 in the past 3 years, so I'm pretty sure there are people out there with extra chairs. FWIW I've read on these boards that Medicare has been denying new chairs after 5+ years if the chair can be 'refurbished' (with new upholstery, back, caster, etc) they will only pay for the parts. Also, unless it's needed for mobility in your home, Medicare doesn't pay. Ironically, they don't pay for home health services either. So, they won't help pay to get you out of the house nor will they pay for a doc or nurse to come to your house. Gotta love it. I hope it's changed or changing soon for the better...
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  5. #5
    55 and Dale,,,, Thanks for the reply's. 55, what you said is kinda what I figured but wasn't sure. Thanks,,,,,Freej

  6. #6
    freej...contrary to the norm. dunno if i have an awesome dme or what but....i've gotten 2 power chairs and just after 3 yrs got approved for a tilite zra. go figure? lol.

    i guess it's how gooda dma ya come across.

    ebay is a good resource for cheap manuals btw.

  7. #7
    Keep in mind that current Medicare criteria for a power chair requires that you 1) must need it for mobility INDOORS IN YOUR HOME, and 2) it must be fit by a therapist or physician who is certified by RESNA for this purpose.

    If you ask for a power chair for community mobility and say you can use a manual chair in your home, they are very likely to deny the power chair. It is critical to work with a therapist (usually a PT or OT) who has the RESNA certification and who works closely with the appropriate vendor or DME so that all can help with the medical justification (your physician will have to sign this as part of the prescription). If you are asking for replacement chair, the therapist will also have to indicate in the letter why your current chair is no longer medically appropriate and cannot be repaired or modified.

    (KLD)

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