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Thread: medicaid/medicare paying for wheelchair

  1. #11
    Senior Member jschism's Avatar
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    it is illegal for a DME to charge you more than the co-pay for medicare/medicaid. a dealer wouldn't risk that. however, they could possibly say that certain "extras" aren't covered by insurance and charge full price for those, but that should be clearly noted in paperwork.

  2. #12
    Quote Originally Posted by addiesue View Post
    Are you close enough to go to Shepherd? Would they know and be able to handle this?
    i can get to shepherds, thats where i did rehab it's just a 4 hr. drive. what would i need to do? make an appointment for a seating eval?

    i dealt with a different guy last time. he got me a zra but i screwed up my measurements, especially the footrest width, i have no taper and also frontend height, leg length that makes it very uncomfortable for me.

    i know this may sound ignorant but how would i figure my 20% copay of like $2700. i'm awful with math, lol.
    Last edited by rollin64; 12-01-2011 at 06:56 PM.

  3. #13
    Senior Member DaleB's Avatar
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    Medicare is reimbursing ~$1800 towards a K0005 chair and the patient is only responsible for the usual 20% of that amount as co-pay. However, any options ordered above and beyond the base chair can be added after the fact, if not part of the script and the coding on the billing paperwork (e.g. power assist). I'm confused about the competitive bidding process and how it will effect what types of chairs we can get. DME's can't change prescriptions to suit their margins, can they?
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  4. #14
    Senior Member ~Lin's Avatar
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    I have medicaid but no medicare. When I was looking things up for myself, they said medicare covers 80% and medicaid then covers the 20% left.
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

  5. #15
    Quote Originally Posted by DaleB View Post
    Medicare is reimbursing ~$1800 towards a K0005 chair and the patient is only responsible for the usual 20% of that amount as co-pay. However, any options ordered above and beyond the base chair can be added after the fact, if not part of the script and the coding on the billing paperwork (e.g. power assist). I'm confused about the competitive bidding process and how it will effect what types of chairs we can get. DME's can't change prescriptions to suit their margins, can they?
    so you're sayin, medicare will cover only $1800 on a a K0005 base chair max? any extras, like anti tip bars and so on is extra out of pocket?

  6. #16
    Senior Member Broknwing's Avatar
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    I *THINK* what was being said is that your prescription has to specify EVERYTHING that you need in order for Medicare to cover it ie:anti-tip bars, taper, solid seat pan, adjustable back rest, etc...otherwise they'll be considered options & be added on afterwards at full list price and you are responsible for them out-of-pocket...
    'Chelle
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  7. #17
    Quote Originally Posted by Broknwing View Post
    I *THINK* what was being said is that your prescription has to specify EVERYTHING that you need in order for Medicare to cover it ie:anti-tip bars, taper, solid seat pan, adjustable back rest, etc...otherwise they'll be considered options & be added on afterwards at full list price and you are responsible for them out-of-pocket...
    i got ya.....

  8. #18
    Earlier in the year, my PT was looking into getting me a lighter wheelchair, because the one I have (Quickie GP) is too heavy and I was starting to get what she refered to as "wheelchair shoulder". We talked to a local medical supplier and he told me that Medicare pays 80% and Medicaid pays 20%, if you are on both of them at the same time.

    Unfortunately, because of that stupid "indoor-only" rule, the medical supplier told me that Medicare rarely covers ultra lightweight manual wheelchairs. I had wanted a Quickie GT wheelchair, but the supplier told me that Medicare would refuse to pay for it, claiming that if I couldn't push a standard wheelchair indoors easily, then I needed a power wheelchair. I absolutely DO NOT want a power wheelchair. I wish the Medicare DME rules were different. Not all disabled adults want to spend their time indoors, and the standard wheelchairs are way too hard to push around for long distances indoors and outdoors, especially on uneven terrain.

  9. #19
    Does anyone have anymore tips or ideas on this topic? I'm about to start the process and really want a nice tilte ZR series 2. Will this be an issue. I'm sure things like spinergy's and D's locks will be hard to get, but you can pay the difference. Although someone told me that with both Medicare and Medicaid you could not. Why would this matter? If the case may be why couldnt you just submit it to Medicare only?

  10. #20
    Senior Member ~Lin's Avatar
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    I was told with medicaid you couldn't upgrade. I think its to prevent balance billing. Something like spinergys and Ds locks though you can purchase out of pocket after you've gotten the chair.
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

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