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

  1. #41
    i gave a call to my case manager and spoke to him briefly about getting a letter of medical necessity, so i can go see a seating specialist... from what he tells me, according to the guideline he follows, he can provide one only if i "cannot self-propel in a standard wheelchair using arms and/or legs"... if that is the case, i do not qualify, but is that right? it's written under the "Claims for a lightweight wheelchair (K0003)" section... i'm confused, what should i tell my case manager?

    here are the scans of the documentation checklist he provided me:






  2. #42
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    Quote Originally Posted by dnaL0R View Post
    i gave a call to my case manager and spoke to him briefly about getting a letter of medical necessity, so i can go see a seating specialist... from what he tells me, according to the guideline he follows, he can provide one only if i "cannot self-propel in a standard wheelchair using arms and/or legs"... if that is the case, i do not qualify, but is that right? it's written under the "Claims for a lightweight wheelchair (K0003)" section... i'm confused, what should i tell my case manager?

    here are the scans of the documentation checklist he provided me:





    Where did you find this? thats some good info.

  3. #43
    Quote Originally Posted by randomryan007 View Post
    Where did you find this? thats some good info.
    my case manager printed it out for me...

    i believe this and other useful information can be found on this link:
    http://www.cms.gov/center/dme.asp [originally posted by cheesecake]

  4. #44
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    not to knock on your case manager but they are morons. I am in arizona and we have avocates that look after our best intrests. and my advocate is not happy with my DME. maybe you should look into getting an advocate.

  5. #45
    Quote Originally Posted by randomryan007 View Post
    not to knock on your case manager but they are morons. I am in arizona and we have avocates that look after our best intrests. and my advocate is not happy with my DME. maybe you should look into getting an advocate.
    i see where you are coming from, but this guy is not as bad as i make him sound...

    my case sort of got on hold since he said he could not do anything further since i can propel the chair by myself... instead of throwing the case in the "pending" file, he actually followed through and did some more research[?], since he sent me an email earlier today stating that he is setting up an appointment for me at rancho los amigos... so he must have figured something out, i mean, what he originally told me did not sound right; seemed like a requirement to get a powered chair or something in that nature...

    it is too soon for me to tell, but it is definitely starting to go in the right direction... i will be giving him a call tomorrow to follow up.

  6. #46
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    Quote Originally Posted by dnaL0R View Post
    i see where you are coming from, but this guy is not as bad as i make him sound...

    my case sort of got on hold since he said he could not do anything further since i can propel the chair by myself... instead of throwing the case in the "pending" file, he actually followed through and did some more research[?], since he sent me an email earlier today stating that he is setting up an appointment for me at rancho los amigos... so he must have figured something out, i mean, what he originally told me did not sound right; seemed like a requirement to get a powered chair or something in that nature...

    it is too soon for me to tell, but it is definitely starting to go in the right direction... i will be giving him a call tomorrow to follow up.
    Good luck Man. All I can say is I have been getting the run around for months. Yes I am on medicare and medicaid. we even tried using my wifes insurance. What a night mare. Hey If I were you I'd push for a Icon Or a Q7.
    Q7's tip easy so becareful if you choose that route. TA7 is alot of hard wear that could fall off. but it looks kool. Tilite just wasn't for me. I sat in a Q7 and I fell inlove. althou I am a quickie guy. The Icon Really has a sex appeal. and I really like it but Dam You really have to have a good seating write up about why you need that chair. I would love to have one. concidering I have owned my GPV for 7 years almost 8.

  7. #47
    Quote Originally Posted by randomryan007 View Post
    Good luck Man. All I can say is I have been getting the run around for months. Yes I am on medicare and medicaid. we even tried using my wifes insurance. What a night mare. Hey If I were you I'd push for a Icon Or a Q7.
    Q7's tip easy so becareful if you choose that route. TA7 is alot of hard wear that could fall off. but it looks kool. Tilite just wasn't for me. I sat in a Q7 and I fell inlove. althou I am a quickie guy. The Icon Really has a sex appeal. and I really like it but Dam You really have to have a good seating write up about why you need that chair. I would love to have one. concidering I have owned my GPV for 7 years almost 8.
    i am sorry to hear about your poor experiences... i hope i can get that write up pretty soon and i will be on my way to rancho, i have heard from another member on here that they have various demo chairs there that i can test out, so i am pretty excited... my battle has just begun...

    :knock on wood:

  8. #48
    Senior Member NW-Will's Avatar
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    I started the process back in June 2011, June 15th.
    Had the chair fitted and everything.
    My DME called me today and told me Medicare only pays for a chair after 5 years!
    Even though they never paid for my original chair.
    Been in my original chair coming up for 4 years now.

    Supposed to be getting it because my current chair doesn't fit me properly.

    Just another bump in the road I guess... the joys of SCI.

  9. #49
    I too am having trouble obtaining a decent ultra lightweight wheelchair through Medicare. The local medical supplier told me that because of Medicare's rules, I was only able to get a standard lightweight manual wheelchair, because of their "indoor-only" policy. He told me that I would qualify for a standard wheelchair like the Breezy Ultra 4, or E&J Metro IC4, but not a Quickie 2HP or any Quickie rigid frame wheelchair. They told me that if i couldn't move the standard chairs around that are mentioned above, then they'd recommend I use a power chair. I can move the chairs and stuff, but it would be hard to do this everyday, due to the weight of these standard chairs. I don't want a power chair, EVER! This was back in April when they told me all of this.

    Has the rules changed recently? A friend of mine who is on the same type of social security program as me (Adult Child Disability Benefit) got an ultra lightweight chair with the E-Motion power assist and Natural-Fit handrims no problem. He is on both Medicare and Medicaid, like me, but I keep getting the runaround.

  10. #50
    Quote Originally Posted by NW-Will View Post
    I started the process back in June 2011, June 15th.
    Had the chair fitted and everything.
    My DME called me today and told me Medicare only pays for a chair after 5 years!
    Even though they never paid for my original chair.
    Been in my original chair coming up for 4 years now.

    Supposed to be getting it because my current chair doesn't fit me properly.

    Just another bump in the road I guess... the joys of SCI.
    this will be my first chair thru medicare/medical, so i should be ok... is it possible that they've paid partially? that is how it was for my first/current chair, though, it was thru private insurance...

    i got an update from my case manager and he told me that they've already sent out a referral to rancho for a seating eval... just waiting on a call back and hopefully i can make an appointment soon...

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