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Thread: Will Medicare/Medicaid Pay For A TiLite Chair?

  1. #11
    Senior Member wtf's Avatar
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    Quote Originally Posted by t8burst View Post
    I don't have Medicare so don't know the logistics of it all but if possible I would consider an Icon. I demoed one last week and really liked the suspension and how it handled. I have a ZRA that is only a year old, if I was buying today I would go for an Icon over the ZRA I have.
    I read some of the posts on the icon and I do like the idea that its adjustable. If I read right, the user could be in the chair and tweak it, thats really innovative (sp?). But I really don't dig the look of the chair, I know I'm probably the only one. I can understand you guys need suspension and all the other stuff. But I'm not doing anything crazy with my chair, I'm not hard on my chair at all. I just need a simple lightweight chair thats practical for my everyday use.

  2. #12
    Senior Member ~Lin's Avatar
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    I personally don't like the look of the chair aesthetically. The functionality of the chair though outweighs that for me and if it was an option I would definitely try going for it.

    Quote Originally Posted by SCI Boot Camp View Post
    From my experience, you can get a Ti Lite from Medicare, but it has be the ZRA and it must be aluminum, not TI. There is that darn 'allowable' thing and they will cover up to that amount, I think the billing code is K005 or K006. Some one correct me if I am wrong...
    So the they approve to pay for the cost of the ZRA, lets say $2700 as an example, then the price difference for the TI comes out of your pocket, generally about 600-880 bucks more just for the frame.. Aluminum is actually lighter than TI, but the TI is more durable and will last longer. Hope this helps a little.
    I think the ZRA Is a K9 chair. I'm a bit confused at your post, because it sounds like you're describing balance billing which I think can't be done with medicare. Balance billing is where you can pay for upgrades from what medicare won't cover, and isn't allowed because it can be used for medicaid/medicare fraud. I know medicaid doesn't allow it, DMEs with a medicaid contract (in IN at least) can't even sell items as self pay to anyone with medicaid as it violates the contract.
    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.

  3. #13
    Quote Originally Posted by wtf View Post
    I read some of the posts on the icon and I do like the idea that its adjustable. If I read right, the user could be in the chair and tweak it, thats really innovative (sp?). But I really don't dig the look of the chair, I know I'm probably the only one. I can understand you guys need suspension and all the other stuff. But I'm not doing anything crazy with my chair, I'm not hard on my chair at all. I just need a simple lightweight chair thats practical for my everyday use.
    The get the ZRA ultralight edition. It is what I have and is so easy to get it in and out of my car. I had an aero-z before that and it was a brick compared to the ZRA. When you are pulling the cair over you and into the passenger seat every pound counts and I love how light my chair is.

  4. #14
    I think you can still pay for the difference if you are on Medicare only.... If you have Medicare/MediCal or Medicare/Medicade then yes, you are not allowed to pay for the upgrades. I guess the thinking is, if you can afford to pay for the upgrades (Titanium frame) then why do you need medical/medicade... You are right, Lin it very well could be a K9 billing code.
    SCI Boot Camp

  5. #15
    Yes, Medicare will pay 80% with a participating Durable Medical Equipment supplier. I do not know abt Medicaide. My Medicare HMO paid 20% of my newest one along with emotion wheels. I paid the 20%. Weigh your costs. My main ZRA i bought on ebay for $1000.00 with a few hundred in customizing for me.....buy what will cost you least and fit you best. My experience, most dme's are horrid unless you're paying for whatever out of pocket.
    "The sweet is not as sweet without the bitter"
    ~"Vanilla Sky"~

  6. #16
    Senior Member wtf's Avatar
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    Quote Originally Posted by t8burst View Post
    The get the ZRA ultralight edition. It is what I have and is so easy to get it in and out of my car. I had an aero-z before that and it was a brick compared to the ZRA. When you are pulling the cair over you and into the passenger seat every pound counts and I love how light my chair is.
    Tilite has an ultralight ZRA edition? My zra is about 3 years old and it still works great, its just scratched up some. My chair is light enough I can drag over me pretty easy. But if there's an even lighter chair then I'm all for it.

  7. #17
    Senior Member wtf's Avatar
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    Quote Originally Posted by SCI Boot Camp View Post
    I think you can still pay for the difference if you are on Medicare only.... If you have Medicare/MediCal or Medicare/Medicade then yes, you are not allowed to pay for the upgrades. I guess the thinking is, if you can afford to pay for the upgrades (Titanium frame) then why do you need medical/medicade... You are right, Lin it very well could be a K9 billing code.
    So medicare will pay (80%) for a tilite zra? But what counts as upgrades?

  8. #18
    Senior Member ~Lin's Avatar
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    medicare pays 80% of whatever chair is approved. If you have private insurance or medicaid as well as medicare, it will pay the remaining 20%. Medicaid is state dependent, so how it works if someone just has medicaid will depend on the state. In indiana medicaid paid for my chair in full.
    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.

  9. #19
    Quote Originally Posted by wtf View Post
    Tilite has an ultralight ZRA edition? My zra is about 3 years old and it still works great, its just scratched up some. My chair is light enough I can drag over me pretty easy. But if there's an even lighter chair then I'm all for it.
    Yeah, it has the carbon fiber axle, cf back release , titanium footrest, titanium backrest, single sided forks and titanium fork stems. My chair with the dinos, back and cushion weighs 22 pounds. Never weighed just the transfer weight, but it me likes it. If you go to sportaid it is the "superlight edition"

  10. #20
    I have a Quickie 2 currently that I've had for 5 years and it is horrible. It is so extremely hard to push. I would even be willing to pay the difference for a ZRA, but from the looks of it it seems that is not possible if you have medicaid and medicare. I feel like I'll never get a new chair and I dont just want to settle for anything since the next one I get I will have for the next five years.

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