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Thread: New Wheelchair with Highmark BCBS

  1. #1

    New Wheelchair with Highmark BCBS

    Does anyone know how often you can get a new wheelchair with Highmark Blue Cross Blue Shield? When I got my wheelchair about 4 years ago, rehab told me that it was every 5 years. I called Highmark today to check and the girl I spoke with told me that there wasn't a specific time frame. She said as long as it was medically necessary it would be covered. That doesn't sound correct to me. Obviously it is medically necessary. That doesn't mean I can get a new wheelchair every day. So I'm kind of confused by this. Anyone have any suggestions?

  2. #2
    If your old one is causing issues you can occasionally get a new one sooner. Ex its too small and rubbing your legs causing a sore, etc.
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  3. #3
    Senior Member ~Lin's Avatar
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    I believe she means medically necessary to have a NEW wheelchair, not medically necessary to USE a wheelchair. Like addiesue said if something was wrong with your current chair it sounds like your insurance would cover a new one even if it hadn't been long since you got the one you have.
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  4. #4
    Quote Originally Posted by tarantella View Post
    Does anyone know how often you can get a new wheelchair with Highmark Blue Cross Blue Shield? When I got my wheelchair about 4 years ago, rehab told me that it was every 5 years. I called Highmark today to check and the girl I spoke with told me that there wasn't a specific time frame. She said as long as it was medically necessary it would be covered. That doesn't sound correct to me. Obviously it is medically necessary. That doesn't mean I can get a new wheelchair every day. So I'm kind of confused by this. Anyone have any suggestions?
    If they are like Aetna, I was able to get a new chair a year after my original one. My original chair was fitted for me in rehab while I was wearing a TLSO. It was way too big, combined with the weight of transferring into my car giving my bursitis in my elbow I got approval for an ultra light chair (ZRA) as opposed to the chair I had (AeroZ). Just needed a PT to write the reason and a doctor to sign it. In other words you would need some change in your physical condition or other reason to get a chair before 5 years.

  5. #5
    Yes you need a drastic change in your medical condition so much so that the cost of upgrading your current ride would cost more than a new chair and/or the parts to retrofit your current chair do not exists.

    And also they have pretty successfully pushed that general rule of 5 years out to 7 to 9 years. And the new system and payment for chairs is criminal insurance companies follow medicare/Medicaid policy closely and there policy is currently reimbersement paid for your chair will be the price of the lowest selling price on the internet for a comparable chair on the day your paperwork gets approved so if you don't have secondary coverage you can end up eating a large bill for a new chair. YMMV

  6. #6
    we are getting a new chair for my son after 2 1/2 years. I think the 5 year rule was a general guide, maybe the insurance companies are starting to understand that is unrealistic and each case is different.

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