Results 1 to 7 of 7

Thread: Dme

  1. #1

    Dme

    After I was injured my insurance through work paid for all my DME, back in 11/03. Since then, I waited 6 yrs before attaining a new powerchair through Medicare. I want to get into a ultalight rigid manual chair, but have been told, power or manual, Medicare won't pay for both. The thing is Medicare has never bought me a manual chair or a LAL matress. Am I wrong or do I need to approach this another way ? The folding manual was bought FOR me w/OT's ideas and no input from me is damn near useless to me unless I want someone to push me. That's motivating, I wanted to gain strength, stamina, and confidence by PUSHING myself. I don't want to knock myself out of recieving another powerchair later. Will someone give me some direction on getting a new chair at no cost. It's a shame that my secondary insurance, which used to be my primary won't pay for me to have the chair that should've been bought in the first place. I'll shut up and listen for approaches. Thanx, mark

  2. #2
    Senior Member
    Join Date
    Aug 2007
    Location
    last house on the left
    Posts
    9,791
    Be very careful here because Medicare has you listed as using and needing a powerchair. You probably do not want to change that because buying a manual chair is MUCH cheaper than a powerchair. We all know that most people need both, but keep Medicare for the more expensive chair and try to get the manual some other way, including buying it outright at online discounts.

  3. #3
    Currently Medicare will pay for one chair every five years, beginning with the first chair they buy for you. The need must be appropriately documented. To them, what you used and who paid before that first chair is irrelevant. They only look at your current status. To them, right now trying to get a second chair would possibly get you investigated for attempted fraud. Follow Eileen's advice. I am trying to get my first chair from Medicare and it ain't fun.
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
    http://cccforum55.freehostia.com/

  4. #4
    I got my first pc from Medicare on 2002 and been trying for two years to get back in a manual. The problem is they do not want to let me go back to a manual. They will gladly buy me a 15k pc but not a 5k manual. I finally said f'em and just bought my own, (2 actually).
    Life's perceived journey in this PMR is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out, shouting "holy **** what a VR ride!"
    Pete C6/'97

  5. #5
    What y'all said was what I've been told. I was hopin' you could steer me to a new chair at no cost. Any suggestions ? I'd be happy to do some swappin'. mark

  6. #6
    As mentioned, Medicare doesn't understand the potential need for many to have a power chair and a manual chair. They will not pay for both, and will only pay for 1 chair every 5 years.

    So you need to pay yourself if you want something now.

    If you want to submit (after 5 years) a prescription for a manual chair instead of getting a power chair, it is a little risky. If Medicare accepts it, then you may have trouble getting another power chair again in the future. It is possible of course, but knowing how Medicare works, it will be painful...

    My dad qualified for a powerchair, so we got a Tilite ZRA + power assist Emotions. I don't think many people submit claims to Medicare for power assist, so it didn't go through smoothly. May be better now. Our provider made many mistakes in coding, and it took more then 1 year to be processed. And we still had to pay some $ ourselves.

    So Medicare paid for.... only the medically necessary items. Never anything they consider an upgrade.

    the basic ZRA chair (which included a pair of regular wheels)
    solid tires
    soft roll casters
    armrests
    leg straps
    anti-tippers
    seatbelt
    Roho
    Emotion wheels

    BUT... they didn't pay for the frame adjustment upgrade necessary so that you could use the emotion wheels on a Tilite frame. $360. Our secondary insurance paid (BCBS). AND they didn't pay for the ?brackets to attach the wheels to the chair. $534. BCBS paid. I suspect that if I had fought with medicare, they would have eventually paid for these, but they rejected my initial appeal (they always reject initial appeals, as I'm sure you know) and fortunately BCBS paid so I gave up on medicare. But of course, how could Medicare approve of power assist wheels, but then refuse to pay the extra $900 to attach them to the chair?

    They did NOT pay for...

    push handles
    camber tube
    upgraded wheel locks (uni-lock)
    tension adjustable seat back
    side guards

  7. #7
    Senior Member
    Join Date
    Jan 2004
    Location
    Whately, MA United States
    Posts
    2,685
    Blog Entries
    2
    There's a TiLite ZRa for sale on Ebay for $590 right now: http://cgi.ebay.com/TiLite-18X17-ZRA...item19c5762978
    I consider something like this a better plan than possibly screwing up your next PC order. If you watch Ebay for a few weeks or more, you will probably find something that suits you for a decent price.
    Don - Grad Student Emeritus
    T3 ASIA A 26 years post injury

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •