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Thread: New Chair through Medicare - What are my options, things to watch out for?

  1. #61
    Senior Member NW-Will's Avatar
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    aaargh... like SCI doesn't make you want to give up as it is without having to deal with endless crap.

    sure makes me wonder if there isn't a place for a sci/medicare equipment DME cooperative.

    So I've been asking my DME for a copy of the paper work they submitted to medicare, wouldn't have thought that was so unreasonable.
    Still waiting....

    So my doctors prescription for the chair is June 2011, today they send me a highlighted page from the DME manual.. I have to laugh but the version of the manual is dated December 2011. They can update the manual faster than things can move. So they still haven't sent me any details of what they sent out initially, just this.


  2. #62
    Senior Member NW-Will's Avatar
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    The Saga continues....

    What have I learnt...
    If you ever purchase a chair yourself, never ever have any modification on it carried out by Medicare. If you do, Medicare will use the dates of that chair in any justification process.

    admc - advanced determination of medicare coverage request

    This is what a DME submits to see if medicare will pay for your chair, this makes the process no risk for the DME. If this comes back ok then your chair will be paid for by medicare. How the process works after this I don't know, haven't made it that far. This seems completely no risk to the DME, I don't understand why DME's are so hesitant to submit this paper work. From what I can see it's a case of collating paper from your doctor and PT and faxing it to medicare. I really don't even see why a DME has to be involved with this.

    Medicare turns around an ADMC request in four weeks.


    This is my timeline so far.....

    5/23/2011 - Initial referral to PT/OT for wheelchair from Dr.

    6/15/2011 - Seating evaluation with PT

    6/25/2011 - Receive CAD of Wheelchair from Tilite

    7/20/2011 - Letter of Justification by PT dated

    7/23/2011 - PT submits paper-work to DME

    8/17/2011 - Letter of Justification Signed by Dr.

    8/18/2011 - Letter of Justification faxed from Dr.'s office

    9/14/2011 - Prescription signed by Dr.

    9/15/2011 - Signed prescription signed by Dr. and faxed from hospital

    2/1/2012 - Initial Fax sent from DME to Medicare

    2/22/2012 - Response from Medicare

    2/27/2-12 - Response from Medicare stamped received by DME

    3/16/2012 - I receive medicare response from DME to initial ADMC submission.

    4/24/2012 - I receive initial ADMC paperwork DME sent to Medicare.



    So from 9/15/2011 until 2/1/2012 my DME did nothing!!

    5 1/2 months !!

    Yes I was calling for status updates....

    My DME is telling me that they don't apply for new chairs until the old one is 5 years old.

    I phoned medicare and asked if I could change vendors and if it would effect the process at all. The medicare representative tells me there is no reason she can see that changing vendors would cause any problem, and if I have the correct paperwork submitted my chair request would be processed.

    I thought I had struck a moment of inspiration, figured I would call Ti-lite and ask them if they could recommend a DME that works well with Medicare, or has success, or is motivated etc. Struck out, all they could tell me were dealers in my area.

    So I called the three recommendations. Explaining the situation.
    First one tells me they won't apply for a medicare chair unless the old one is at least five years old!
    Second one tells me they don't even deal with Medicare.
    Third one.... I'm waiting for a call back.


    If I had a justifiable denial from Medicare I could understand, but I really don't feel like Medicare is even being given a chance to deny me on justifiable medical grounds.... what gives...

    Here is the initial ADMC request that was sent in by my DME.

    Page 1

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