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Thread: Insurance paying for new powerchair?

  1. #1

    Insurance paying for new powerchair?

    First new w/c request in 8 yrs
    Wtf? My power chr went in for repairs and since so much is wrong with it (it’s 8 yrs old), a request was put in to Regence Blueshield to replace it. They sent a response that says they don’t preauthorize, here’s our policy, you figure out if we’ll pay. If you interpret the policy wrong, well, your buck. Not the precise terminology…but that’s the letter in a nutshell.

    So here’s several pages on their policy regarding w/c eligibility with NO reference to cost of repair vs. replacement or time between getting a new chair (used to be 5 yrs), all in print you need a magnifying glass to read.

    In all my 23 years of using a chair, I’ve never seen a response like this. They either authorized it or not. So, let me get this straight: it’s my job to figure out their policy, then order the chair and let me guess…they’ll tell me I don’t fit their criteria and I’m stuck with the appeals process, possibly paying thousands for the chair. GEEEESH….SCI SUCKS.

    Maybe I’ll make a preemptive strike and call the media now.

  2. #2
    You may need to get the prescription for the chair and submit that (which is what Medicare now requires, and many insurances have adopted Medicare guidelines). You don't necessarily have to order the chair first, but you need to have a detailed prescription and letter of medical necessity detailing a rationale for every feature of the chair. It is definitely a pain.


  3. #3
    Senior Member
    Join Date
    Mar 2009
    New Mexico
    Confused: I have read here on some of the threads that you should undergo a seating evaluation prior to submitting a request for a new wheelchair to your insurance company. And that request needed to be very detailed. So, I called my insurance company to ask them what they required. They told me that I needed a note from my physician stating that I needed a new wheelchair. I was to then take the note to a specific DME provider, who would evaluate me and put their recommendations in for prior authorization. So my question is: What should my physician write in his prescription for a new wheelchair? My plan is to be evaluated for either a power chair or a power-assist chair, but until I am evaluated I don't know which type of chair is more appropriate.

    Help please!

  4. #4
    For power chairs (which is the topic of this discussion), Medicare requires that you have a seating and wheelchair evaluation done by a therapist who has received certification from RESNA for this. They actually write the letter of medical necessity, which the physician just signs (in my experience), and that goes to Medicare to authorize. Commonly they will deny parts of it, and approve parts of it, so you have to choose to either eliminate the features they will not cover, or pay out of pocket.

    This is not currently required for manual wheelchairs with Medicare.

    Your individual private insurance may or may not use Medicare guidelines. Every company is different. I would NOT be expecting a DME to know how to fit you properly or to guide you to the right chair...they are SELLING you the chair and will more often than not direct you to the most expensive chair and features, and not those that are really the best for you. If possible, get the chair evaluation done by a therapist who knows what they are doing (often in a seating clinic at a major rehab center), get them to write up the prescription, and then take this to the DME to order EXACTLY as prescribed. The DME should check with your insurer to see if they will cover the specific chair and features PRIOR to ordering it. Again, your physician should sign the letter of medical necessity written by the therapist, and call this their prescription as well.


  5. #5
    my situation is diff from that above. just wanted to say i spoke to the DME provider today about the letter (same provider i've been dealing with since 1997, gotten 2 new powerchairs thru them) and they were taken aback by this response, too, although not fussed.

    they are carrying on, making some calls and i will be, too. i know exactly what i need so no eval is necessary. i'll keep you updated.

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