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Thread: Medicare paying for chair repairs bought by private insurance

  1. #1

    Medicare paying for chair repairs bought by private insurance

    My husband received a power chair in Feb of 2009 when he was at Craig Hospital in CO. At the time we had private insurance which paid for it.
    It has since needed repairs and because we live in MN had it repaired locally.
    In April he started Medicare. We no longer have private insurance.
    Medicare is telling the local DME that since they did not pay for the chair they do not have to pay for the repairs.
    I am trying to get the CO DME to fax the records to the local DME and am getting the run around.
    When we needed a new sling for the hoyer-ceiling lift we ran into the same thing and I just paid for it.
    The chair bill is in the $1800 range which I do not have.
    Has anyone run into this situation?
    Last edited by Jim; 10-26-2011 at 02:02 PM. Reason: typo

  2. #2
    Senior Member ryano's Avatar
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    I ran into the same type situation with my insurance company about making repairs on my manual chair. They declined it because they did not pay for the wheelchair. Since medicare sets the standards for all insurance companies (or so Ive been told) I wouldnt doubt it at all.

  3. #3
    Senior Member DaleB's Avatar
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    I ran into this on my manual chair. Medicare wouldn't buy parts for my GT, since private ins bought it. I was advised to submit for a full replacement, which they will pay for. So, in order to save a few hundred $ on parts they'll spend $1800 toward an entirely new chair. Stupid.
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  4. #4
    I'm sorry you are having so much trouble with Medicare (or maybe you are having trouble with the durable medical equipment company - they often blame things on Medicare that aren't the case so they don't have to deal with Medicare - it does happen. It is also possible that the DME supplier you are trying to work with is not an approved Medicare supplier or they do not accept the specified reimbursement for the repairs.

    However, I got my new power chair through private insurance in December of 2009. I started on Medicare in June of 2010. The chair has not needed much in the way of repair, but several repairs have been made and paid by Medicare. One of the arms on the chair was replaced because the stop tab broke off. Another time, I began having an oil leak from the tilt mechanism and the repairman took it apart, inspected, repacked and lubricated it.

    None of these repairs came close to $1800. I called the sales/repair shop I have used for years and asked about Medicare repairing my chair. They said there would be no problem and they would submit all the paperwork. I called Medicare, just to double check how they would handle repairs on my chair. They did have some questions about how long I had the chair, what was the estimated cost of the repairs. They asked if the chair was in need of replacement. I told them it was not, it just need these repairs and replacement parts and they said there would be no problem.

    Linda, it may be that $1800 of repairs is a large enough number that Medicare then begins to consider replacing the chair rather than fixing it. That may be what your durable medical equipment supplier is getting to when they say Medicare won't pay for the repair. I would call Medicare and get the information directly from them.

    Here are a couple threads from the past. It does sound like more people have had your experience than have had mine. Most people just take the path of least resistance with Medicare and have them buy a new chair. They they have a every 5 year replacement rule.

    http://sci.rutgers.edu/forum/showthread.php?t=129352

    http://homecaremag.com/mobility/whee...imit-20090518/

    All the best,
    GJ

  5. #5
    Senior Member rdf's Avatar
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    Have Medicare buy you a new chair if you can't afford the repairs, Linda. Since private insurance bought Dave's chair originally, then Medicare has never purchased you a chair, so they'll buy you a new one. Then after that, every five years they'll replace it with another new one. Best of luck.
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  6. #6
    That what most people have to do. It is a shame they would rather pay a fortune for a whole nes chair than just fix the one you have, but they do. And everyone else out there wonders why there are issues with Medicare funds and waste...
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  7. #7
    Because the chair was just over $30,000 (sip n puff etc) it seems they would rather pay for it.
    Because he has gained weight (no lectures please) the chair was "grown" along with some other repairs and maintenance.
    This is a smaller DME than the one we had all the problems with last year and seem to be knowlegable about the ins and outs of Medicare. I really liked that they were more personable and came to our home as they are 40 miles away.
    I could not imagine what we would have to go through with Medicare to qualify for another chair this expensive.
    At least it is not an emergency this minute like when it was stuck in tilt last year.
    Last edited by LindaT; 10-26-2011 at 03:42 PM.

  8. #8
    Linda, I have been involved with the Medicare-wheelchair insanity for sometime now, and here are a couple findings. Medicare uses a system of regional reviewers to approve costs. They do not all interpret and implement Medicare policies the same. Second, because they did not yet buy a chair for your husband, they would likely buy him a new one if you jump through the hoops and get a Rx and the necessary evaluations. It is totally crazy. They have nothing to do with previous providers. As far as they are concerned, your husband's current chair does not exist on their computer and they have no way of dealing with it.
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  9. #9
    Senior Member TomRL's Avatar
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    Same experience here. Medicare won't repair mine either.
    Tom

    "Blessed are the pessimists, for they hath made backups." Exasperated 20:12

  10. #10
    Senior Member jschism's Avatar
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    like others are saying, get a new chair and have medicare pay for it. unfortunately you will still have to pay for repairs if neccessary to get by for now. when you get new chair, sell it or keep for a spare.

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