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Thread: Pics/remarks of Icon?

  1. #101
    Just for curiosity, insurence pay this type of chair, it`s coded like k0005?

    Or always people will have to pay it from their pocket?

  2. #102
    something stephen said made me wonder - how do you do an uphill transfer on the icon? is pushing off the cushion surface the only option?

    also, there was something grommet said about transferring out in order to quickly change the angle of front end - can it be done without transferring? i had hoped i might be able to change that directly i arrive at my restaurant table to find i have no chance of fitting, and then change back right as i leave. this supposes the qr levers of course...

  3. #103
    I looked and looked, I don't see a "code" with a MSRP of $4295 it must be K0009. Is that correct?

  4. #104
    Senior Member DaleB's Avatar
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    Quote Originally Posted by jakeyboy1 View Post
    I looked and looked, I don't see a "code" with a MSRP of $4295 it must be K0009. Is that correct?
    I don't think the Icon has been assigned a HCPCS code.

    The highest Medicare payout, for a manual chair, is only ~$1,800 for K0005.

    Medicare doesn't reimburse for K0009 but some private insurers do.
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  5. #105
    (speaking from a dealers prospective...)
    It has to be coded to sell it to anybody except "cash" or VA. If it isn't coded.... it will never have huge success.

    The highest Medicare payout, for a manual chair, is only ~$1,800 for K0005.

    Medicare doesn't reimburse for K0009 but some private insurers do.
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    A dealer can bill K0005, dispense a K0009 and have the end user pay the difference (for medicare). If it isn't coded at all, it will stay a "all cash, and VA chair".

  6. #106
    @Stephen212 - you might be right about the level of injury vis a vis Christian, my point was that for people with limited trunk control (like Christian, you, tooley) there's something, likely in addition to, the level of injury that contributes to needing to use structural elements to reposition, and my theory is that your "badonkadonk" is what's to blame. DaleB seems to support my postulation on your posterioration.

    Seriously, dude - you got junk for days in the back - little wonder you don't think suspension is something you need - if everyone had it "built in" like you, Icon would be out of business.

    @jakeyboy and toto - it's currently coded as a K0005, which we're appealing. The coding folks recently coded the Marvel as a K0009, and when I was there, I pointed that out to them, but their previous opinions didn't seem to inform their present ones. We'll keep pushing to have it coded as a K0009.

  7. #107
    Senior Member DaleB's Avatar
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    Quote Originally Posted by jakeyboy1 View Post
    (speaking from a dealers prospective...)
    It has to be coded to sell it to anybody except "cash" or VA. If it isn't coded.... it will never have huge success.

    __________________

    A dealer can bill K0005, dispense a K0009 and have the end user pay the difference (for medicare). If it isn't coded at all, it will stay a "all cash, and VA chair".

    According to CMS, balance billing is against their rules. Their rules are set by Congress, as such are Federal law, and breaking them is a felony.

    Are you saying you do this, bill one thing but deliver another then balance bill the customer, and this is perfectly above board and legitimate?

    I've never worked on the provider side of Medicare but I have extensive experience in the Medicare actuary world and this strikes me as something fishy.

    Can you help me understand how this works?!?

    If I am wrong, I'd love to buy a chair through you. $1,800 off a K0009 chair is better than nothing!
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  8. #108
    Quote Originally Posted by JeffAdams View Post
    @Stephen212 - you might be right about the level of injury vis a vis Christian, my point was that for people with limited trunk control (like Christian, you, tooley) there's something, likely in addition to, the level of injury that contributes to needing to use structural elements to reposition, and my theory is that your "badonkadonk" is what's to blame. DaleB seems to support my postulation on your posterioration.

    Seriously, dude - you got junk for days in the back - little wonder you don't think suspension is something you need - if everyone had it "built in" like you, Icon would be out of business.


    OK, I'll back of the Twinkies. Seriously, I'll concede that my posteriorus is adorable and (mercifully) there is still some skin left to pinch, but I'm not getting much lift off from it.


  9. #109
    Senior Member DaleB's Avatar
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    That's terrific the Icon is coded and 'in the system'! Good luck on the appeal. 9 would be nice. That removes it from consideration as a 'Medicare chair' but would be more in line with the price.

    (fwiw, I wish I had some junk in the trunk. No way I'm making it another 10 years without this layer of nothing but skin breaking down, at some point. )

    Quote Originally Posted by JeffAdams View Post
    @Stephen212 - you might be right about the level of injury vis a vis Christian, my point was that for people with limited trunk control (like Christian, you, tooley) there's something, likely in addition to, the level of injury that contributes to needing to use structural elements to reposition, and my theory is that your "badonkadonk" is what's to blame. DaleB seems to support my postulation on your posterioration.

    Seriously, dude - you got junk for days in the back - little wonder you don't think suspension is something you need - if everyone had it "built in" like you, Icon would be out of business.

    @jakeyboy and toto - it's currently coded as a K0005, which we're appealing. The coding folks recently coded the Marvel as a K0009, and when I was there, I pointed that out to them, but their previous opinions didn't seem to inform their present ones. We'll keep pushing to have it coded as a K0009.
    __________________

    He who hears not me but the Logos will say: All is one.

  10. #110
    @DaleB - the way you characterize it is a bit overstated I think - it's a grey area which I don't understand very well, and is a bit of a moving target - I don't envy the dealers who have to navigate these waters.

    The modularity of the Icon is a benefit here, and was part of our strategy in the concept stage of the Icon - we had a lot of friends who had glass ceilings on the amount of money they could spend, and we quickly saw the mistake we had made last time around with an "all in" price.

    Without violating any laws or statutes, an end-user can buy the base model of the Icon, using whatever funding/allowable they have to pay for it.

    They can then (after delivery) use whatever other means they may have available to them to upgrade parts to get the top of the line version of the chair (carbon seat, sideguards, etc). This helps the end-user get the equipment they need, and also helps get the DME out of a potentially awkward legal grey zone.

    No other manufacturer has a design that allows this to happen - eg. if you buy the Invacare A4, you can never upgrade it to the level of a T7A - it's just not possible, same as if you buy an Aero Z - you just can't upgrade to a ZRA2.

    As an example, with the Icon, you can buy the base model, use your funding, and over time (with private funds or once your annual insurance allowable resets) buy an upgraded carbon seat that saves 1.5 pounds from the laminate one.

    We wanted to provide the opportunity for the end user to build their dream chair over time if financial constraints (driven by funding models or just personal financial realities) made it necessary.

    The laminate seat has all of the functionality of the carbon, but in exchange for a lower cost, there is a higher weight. One of the foundation principles was to maintain full functionality from the base model through to the version with all the bells and whistles.

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