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Thread: How do you get your chairs? I heard insurance will reject even if you say you'll pay!

  1. #1
    Senior Member mr_coffee's Avatar
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    Question How do you get your chairs? I heard insurance will reject even if you say you'll pay!

    Hi guys,

    SO I just went to get fitted for a new TiLite ZR and the guy said well we can try for this if you want but there are some cases where the insurance will reject it even if you say you will pay up front the differences they wont pay for. I was like WTF! insurance is so shit if thats the case.

    The guy even went to the extreme to say in one case he said the insurance company would cover a k5 wheelchair (which is like a quickie gt) but the guy wanted a k9 wheelchair which is like a TiLite ZR. So the guy said okay well I will take the money for the k5 wheelchair and then we'll put that money towards buying the TiLite Zr and the insurance company said that is fraud because you are buying something else rather than using our money to buy what you applied for. I was like REALLY!


    My primary is cigna access plus and my secondary is medicare. I actually told them to omit my secondary insurance because I'm so fed up with medicare not giving me what I need and taking forever to reject it. So I told them I'll pay for everything after the primary insurance is through and the guy gave me a high five after because he knows how much faster I can get the chair.

    So how do you guys get the nice chairs? do you have super uber insurance companies or what? I was under the impression cigna access plus was a good insurance company.

    Hopefully they don't reject it and if they do hopefully they will allow me to pay for some of it and them cover some of it. If not I may just buy the wheelchair myself, I just looked online and a TiLite Zr is like $2,000 which isn't so bad then just submit that claim to my insurance to see if they will pay for any of it (if it comes down to that.)


    I also see a lot of chairs with like custom colors for the frog legs, etc. how do you guys get theses? Do you buy them after you get your chair and put them on yourself? It just seems like insurance is not willing to pay for the bare minimum let alone customization such as color if it adds cost.



    Like this for example I like the color contrast here:



    But how do you get that? The guy fitting my wheelchair asked for colors only on the spokes of the rims, and the wheels (which were all free) but nothing about the frog legs or whatever that bar is called. I just checked on the ti lite order form its an extra $95 to get the colors which is fine with me but I'm thinking he didn't even ask because he thinks it will give even more of a reason to reject the chair if I"m asking for things like color.


    One other question, those are frog legs right? I notice they are blue but when I read the tilite ordering form it says the frog legs are only available in silver.
    Last edited by mr_coffee; 01-29-2010 at 06:04 AM.
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    C7/C8, T1 incomplete;


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  2. #2
    Senior Member wheeliecoach's Avatar
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    Do not know about your insurance...but mine paid as long as my doctor justified the reason for having a higher coded chair. The color coding contrast would probably not be covered and then would be passed on to me along with my 10% copay (if I got the chair from a DME in network). I have not heard of a private insurance company denying a chair unless the justification letter was not explicitly detailed (although I may be living in a box and just have not heard of that happening).
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  3. #3
    Senior Member Foolish Old's Avatar
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    IMHO - The DME needs to have a positive attitude and be willing to do their job. Part of their job is finding and establishing a relationship with somebody at the insurance company that will help them put you in the chair you need. Many DME are lazy and will try to get you to pay the whole cost up-front because they don't want to deal with a single item being rejected. Or they will try to put you in a chair they know will fly through approval. They want paid, the rest is a pita to them.

    My insurance offers pre-approval (not a guarantee of payment, just an indication that the chair is eligible and what they will pay) but many DME don't even mess with that process. You need somebody who sells lots of ultralight chairs and knows how to get paid for them. Don't be too quick to offer to self pay for extras that aren't obvious bling. DME will see that willingness as a quick route to payment and will stop working hard with the INS. Only make that offer when it seems like the only way to get things unstuck.
    Foolish

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  4. #4
    Senior Member WolfeMan's Avatar
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    Make sure your prescription states 'ultra light wheel chair' and you will also need a good letter of 'Medical Necessity' that specifically states any extras you need. My DME writes my letter, the Dr. obviously writes the prescription. Color obviously would not be a necessity. D-locks would be especially for a quad.

    Me personally, I don't care about colors or anything fancy. The chair depending on your lifestyle it gonna get banged up. Keep it simple and the scratches and scuffs won't show as much. Forego the extra non-necessity items especially if you end up having to pay out of pocket, unless they're that important to you.
    Larry
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  5. #5
    here in the netherlands its very eazy . we have 2 types of getting a wheelchair first is treu the town called law social guide .the first time a doc is going to look in your medical dossier .than the diside what kind of chair you are going to get .if thats done and u need another one you just give them a call that your wheelchair is broken ore is more than 3 years and you fill in a form and a new one is provided .if you want something extra thats out of your own pocket ,reperations and tyres payd by my town .the town leases the wheelchairs from a compagny and pay them every month during the contract .also service is free of charge .
    i have 2 chairs the second is by my employers insurance that works almost the same .only its provided for your work so everthing is made so that you can do your work with minimal asking others for help .in my case the gave me a tlite zr with spinergyspox lx and flexrims also carbonfibere fenders on it to protect my cloaths and an ergonomic seating and speacial ajust backrest and a varilite cusion .from my town i have a topend (titanuim) with normal spoke wheels ergonomic seating and also a varilite evolution cushion .btw i had to pay about 90 uds for the anonized pakkage on the tlite .the rest was for free .if i get fired ore cant work anymore i have to give the wc back .

  6. #6
    Senior Member brucec's Avatar
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    Back about 20 years or so ago, I went to get a new E & J chair, was 1800 bucks, the insurance said a reasonable proced wheelchair in my area was 200 dollars, so they paid eighty percent.
    I probably should have pressed on and kept fighting their claims, but i didn't, i just chairs myself from then on and put it on my tax returns
    We must reject the idea that every time a law's broken, society is guilty rather than the lawbreaker. It is time to restore the American precept that each individual is accountable for his actions.
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  7. #7
    I'd try a different DME or go to Sportaide or Bike-On.com. these guys specialize in the right equipment we need. DME's are just paid salesmen. Ours here keeps pushing faunky Quickies on people that would be better off with a different chair but has a stash of them in a warehouse and gets a bigger cut from Quikie than a few of the other manufatuers.

    No, those aren't Froglegs on the chair you posted. Just Ti's fork with blue andoization. Be sure you want Froglegs before buying them. Not sure on what they have now, but the ones I had earlier didnot meet expectations by any means.

  8. #8
    Senior Member mr_coffee's Avatar
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    thanks guys I'll call them to make the doctor change the script! I told the doc that originally but I'm sure she just wrote, wheelchair needed. I really get lucky in finding bad doctors ALL the time. My best doctor I had was at home (and she was just a family doctor and had no idea about SCI) so she actually let me tell her what I need rather than them telling me what I need.

    I just am fed up with the whole system.
    Last edited by mr_coffee; 01-29-2010 at 07:45 PM.
    Injured:10-16-04
    C7/C8, T1 incomplete;


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