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Thread: The future of titanium wheelchairs?

  1. #21
    Quote Originally Posted by JeffAdams View Post
    Both are K0005 chairs, so both are reimbursed at the same amount by the funding source, whether it's gov't or private insurance. The Icon is priced for now at $3,295, and the TiLite AeroZ is $2,195. The dealer was willing to give up some of his profit, but the customer wasn't willing to contribute any amount of money.
    Not to support the customer as he sounds cheap, but was medicare involved as the reimbursement source? I've run into trouble trying to pay anything over the co-pay because they say it would not be legal. Supposedly it is to protect the customer from being over charged. Heck they would not even let me make a side doctor appointment and pay out of pocket because medicare pays for that doctor.
    I have had periodic paralysis all my life. I lost my ability to walk in 2011 beginning with a spinal block, which was used for a hip fracture caused by periodic paralysis.

  2. #22
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    Quote Originally Posted by elarson View Post
    So maybe the lack of insight is not just limited to governments, but also users.
    Completely agree. Whilst our experience is within Australia, and related to a child in a chair (which is funded without any insurance required), it took a lot of effort on my part to convince the organization that we deal with that, despite saving them several thousand dollars, they should fund an Icon purchased directly from the overseas manufacturer, rather than pay for another TiLite locally. (They had a policy of only purchasing from Australian suppliers, despite these suppliers only being another add-on cost that could easily be avoided).


    Since I convinced them that the approach was sound (and that buying "locally" doesn't really mean anything from a warranty perspective, it only adds cost), another part of the same organization has since organized an Icon for another child here in Perth. But it is sad that if the user doesn't do the research, or isn't prepared to push hard enough, nobody else will do it for them....
    Gordon, father of son who became t6 paraplegic at the age of 4 in 2007 as a result of surgery to remove a spinal tumour.

  3. #23
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    My reason for TR3 was I wanted chair that simply weighed the least. I did not add attachments increasing the weight. The cushion, yes a little, but that it a Supracor Sport - hoping it weighs least as well. Total weight of my chair is somewhere in the 11 lbs range. Why does someone need titanium if they are going to add 20 lbs of attachments? I do believe insurance charges and gets paid MSRP. That is a huge increase over amount chair can be purchased on Internet.

  4. #24
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    Another thing I look at on the chairs is the amount of energy going to be absorbed by the chair, instead of transferred through the chair directly to the wheels and the ground on each propulsion. I believe any chair that has more and more movable pieces, each one of those pieces will absorb energy from your arms on each propel instead of directly transferred to the ground and propel the chair.

  5. #25
    @rlmtrhmiles: Then why don't the Tour de France riders have fully welded bikes? Those guys are worried about 1% power/efficiency loss, and every single one of their bikes is adjustable (and not made of titanium, by the way - they're mostly made of carbon, and the entry level ones are made of carbon and aluminum).

    Trivia question: "What super awesome wheelchair is fully adjustable, made of carbon and aluminum, costs less than and weighs the same as a similarly configured titanium ZRA?"

    Answer: Icon fits.

  6. #26
    Senior Member elarson's Avatar
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    For someone who requires a wheelchair full-time, it is more like a combination of an orthosis and a prosthesis than a form of transportation that you can choose to not use. As such, it should be covered by insurance at the same level, for both in the home and the community. The only exception should be any bells and whistles or cosmetics that are not medically necessary, that should remain a choice for the user to pay more for.

    The average price of a higher end ultralight is much cheaper than the average arm or leg prosthesis. You don't see discussions about denying coverage for a custom-made prosthesis that uses titanium or carbon composites. Why should it be any different for wheelchairs? What is really going to blur the lines is when exoskeletons become more ubiquitous.

    Just by way of comparison, the average price of a higher end ultralight is not so different than higher end mountain and road bikes, and in many cases cheaper. Although I don't think wheelchairs used primarily for transportation should be covered, this line is also probably going to be blurred in the future.

    Quote Originally Posted by t8burst View Post
    It is crazy isn't it? My friends didn't bat an eye when I drop 20K on a Ducati but tell them the cost of a new wheelchair, or some nice wheels and people think I am nuts. Hell, I live in a damn wheelchair! There is a weird sense that all medical stuff should be paid by insurance.
    Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

  7. #27
    Quote Originally Posted by JeffAdams View Post
    We get very few private pay customers - the VAST majority of customers will refuse to contribute any amount of money towards their chair.

    I just did an eval with a customer who pulled into the parking lot in a brand new F350, had a nice watch on, trialed both the Icon and a TiLite, said he liked the A1 better (to the dealer, not in front of me), but decided to go with an AeroZ because he didn't have to make a $400-500 contribution.

    It's really hard to make nice things in the wheelchair market.
    Jeff,

    The situation you describe here is exactly why I abandoned development of composite wheelchairs and accessories. The other industries I do composite design/process consulting in produce products that are in no way essential for daily life, but have customers that don't hesitate for a second before spending top dollar for "better" products. As consumers, we demand higher quality not with our voice, but with our pocketbooks.

  8. #28
    Senior Member elarson's Avatar
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    @rlmtrhmiles, I think you are missing the whole point of this discussion. It is about having choices that meet specific user requirements. I am not saying that you are wrong in your determinations about what works best for you, but what works for you may or may not work for someone else. For example Chas who needs ergo seating, or my husband who has less spasms and consequently seizures with the vibration-dampening of titanium and has a need for adjustability because of changing needs.

    Specific materials and components can be debated until the cows come home, but most wheelchair configurations are a compromise, and what is lost because of one limitation, other options can often help make up for. In my husbands situation, he lost some propulsion capability in weight and energy absorption because of needing adjustability, but made up for some of it by having the better strength-to-weight ratio and fatigue resistance of tatanium.

    My biggest concern is that by trying to simplify CMS HCPCS codes by removing K0009 wheelchairs because not all materials or components are easily medically justifiable, people will be limited in their choices. For example, for limb prosthesis functional levels are also used to determine the functional capabilities and potenial of the user. They include ambulation at home, in the community, and take into concern environmental barriers, vocational, therapeutic, and exercise activity -- which is way beyond simple locomotion.

    Where as wheelchairs are entirely based on mobility-related activity of daily living (MRADLs) and only in the home. They should have extened the HSPCS codes to include more options that better fit clinical needs, functionality levels and potential, rather than eliminating an entire class of complex rehab technology just because one aspect or another did not fit neatly into a box.


    Quote Originally Posted by rlmtrhmiles View Post
    ... Was also told there is no justification for titanium over aluminum.
    Quote Originally Posted by rlmtrhmiles View Post
    My reason for TR3 was I wanted chair that simply weighed the least...
    Quote Originally Posted by rlmtrhmiles View Post
    ... I believe any chair that has more and more movable pieces, each one of those pieces will absorb energy from your arms on each propel instead of directly transferred to the ground and propel the chair.
    Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

  9. #29
    Senior Member elarson's Avatar
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    Black Alloy, Sorry to hear that you decided not to go further with your composite everyday chair. The unfortunate thing is that many wheelchair consumers do not have the ability to spend top dollar for "better" products, though I know there are exceptions. That's why I have concerns about innovation being limited to only those who can afford it, because ultimately it is going to limit everyone, even those willing/able to pay for it.

    Quote Originally Posted by Black Alloy View Post
    The situation you describe here is exactly why I abandoned development of composite wheelchairs and accessories. The other industries I do composite design/process consulting in produce products that are in no way essential for daily life, but have customers that don't hesitate for a second before spending top dollar for "better" products. As consumers, we demand higher quality not with our voice, but with our pocketbooks.
    Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

  10. #30
    Quote Originally Posted by elarson View Post
    Black Alloy, Sorry to hear that you decided not to go further with your composite everyday chair. The unfortunate thing is that many wheelchair consumers do not have the ability to spend top dollar for "better" products, though I know there are exceptions. That's why I have concerns about innovation being limited to only those who can afford it, because ultimately it is going to limit everyone, even those willing/able to pay for it.
    The way things are unfolding it appears that future choices outside of the CMS guidelines are ones the the VA system and a few private payers are able to sustain.
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
    http://cccforum55.freehostia.com/

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