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Thread: Medicare pay a portion for high end chair?

  1. #1
    Senior Member
    Join Date
    May 2006
    Location
    Pennsylvania
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    770

    Medicare pay a portion for high end chair?

    I want to get a top quality chair. I'm sure Medicare won't approve payment for such a chair. Does anyone know whether Medicare will pay a portion of the cost and I can pay the rest?
    Thanks for any replies.
    Rich

  2. #2
    Yes.

    They paid for a Tilite ZRA for my Dad (para). Getting the lightweight frame is not impossible. But we emphasized the need for light frame for independence in/outside the house, and prior injury/fragility of shoulders. He is also older (60's). We made the letter of medical necessity as strong as possible.

    But certainly they don't want to pay for any upgrades. So those you will have to do yourself. They did pay for the Roho though.

    They didn't pay for these "upgrades" or "not medically necessary" items:

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

    We got the basic wheels that come with the chair, only. Funny thing is now he does use or dislikes all the above things except the locks. Live and learn.

    The trickiest thing is finding a DME willing to submit one for you, without making you pay upfront. Ours had never submitted a high end chair to Medicare. But they didn't force us to pay upfront - but we did sign an ABN and knew our secondary insurance would help. It is always unclear to me when they can make you pay up front.... As you know the DME wants to upcharge every part from 100-200%, and I don't want to pay that out of pocket!!! If Medicare rejects something, I'd rather buy it myself at list price at the most... and better, at the best price online.

    Fortunately, we had good secondary insurance that paid for everything Medicare did not. However, my questions remains what the DME would charge you for those upgrades that Medicare rejects. Will they charge you the crazy upcharge price?!?! You need to get that clearly documented before you do/pay anything.

    I hope someone else will respond about their experiences. We may need to get a new chair in the next year, and we are losing our secondary insurance...

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