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Thread: Medicare and push handles?

  1. #1
    Senior Member ~Lin's Avatar
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    Medicare and push handles?

    Has anyone heard of medicare refusing to pay for push handles on a wheelchair?

    I've been helping an online friend get her first wheelchair. An Icon. She received it today, but there are a LOT of problems. One of them is it showed up with no push handles. She was told 2 separate excuses, one of them was that the dealer didn't think she really needed them and removed them from the order. She was also told that since medicare only cares about wheelchair use in the house, they won't pay for them. They're around $235 I believe on the Icon order form.

    She's really lucky she HAS an Icon considering the mistakes the dealer has made. She is SWIMMING in the chair, and she complained repeatedly when they delivered the chair and yet they kept telling her she was fine and only adjusted the wheel spacing, would not adjust the chair width. I think part of the reason may have been a combination of laziness and the fact they'd brought a size 16 cushion for her to demo, so maybe they had no other cushion options right now. Speaking with her she said she's swimming in the chair and expressed that she cannot propel it at ALL right now, and feels as if her shoulders are going to dislocate when she tries. The current seat pan on the chair is the narrowest at 14, but she's a size 0 and it sounds as if she may need narrower! She's now thinking she remembers the OT to have measured her around 12 wide. It shouldn't be an issue to swap out the seat pan with Icon, but of course if she needs such a drastic change the backrest will have to be swapped as well. She currently has a comfort company Acta back.

    Any suggestions? She's going to email the OT about the problems and changes the dealer made from what was agreed upon. The chair was also supposed to come with a headrest and didn't. She's going to take photos so I can get a better idea of what parts are currently on the chair. And I told her she should contact insurance and tell them to not pay until this has been resolved, that the chair she has received is NOT the chair that was ordered.
    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.

  2. #2
    For Medicare, medical necessity for use "in the home" is all that's considered.
    Somehow, there needs to be documentation that, without push handles, your friend would not be able to do basic home ADL's because she can't get to her bathroom, kitchen, bedroom, etc.
    One way to do this, since she cant use the push handles herself, is to have documentation that push handles would facilitate your friend's caregiver in moving her around the home to the bathroom for bathing, grooming, toilet, getting her to an area to dress, getting her to the kitchen/dining room for eating and getting her to the bedroom for sleeping.
    Anything involving a friend or caregiver using the push handles to do outside activities would likely be denied.
    Awful? Yep.

  3. #3
    Senior Member ~Lin's Avatar
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    Yes, I stated that medicare only cares about in home. But medicare is paying for her smart drive. She obviously needs assistance in the home, so how could they deny push handles? Its not about documenting WHY she needs the push handles, but if its possible for medicare to completely refuse to pay for push handles flat out for anyone or on a specific chair. She definitely needs them, there's no doubt about that. And I call bullshit on it not being possible for medicare to cover them.

    The DME didn't say that medicare denied her push handles. They said they WOULD deny push handles because medicare only cares about in home use. I believe they're lying to her to cover their own ass. Especially since she was given more than one excuse for the chair showing up without push handles.

    Not to mention its totally NOT OK for the dealer to just make changes to the chair without having discussed them prior to the chair being ordered.
    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.

  4. #4
    You're being a great advocate for your friend. You're right, the dealer should not have made those changes without disclosing them in writing.

    Now please understand the following statement is not my opinion. This is just me looking through the eyes of a line item insurance reviewer going over your friend's chair components. I'm agreeing to pay for a $6,400 Smart Drive to facilitate independent home mobility. Why am I doubling down on the $235 push handles ?

  5. #5
    Senior Member ~Lin's Avatar
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    Exactly. Medicare admits she is unable to independently propel herself around the home and willing to pay thousands to power assist. So why would they refuse to pay a couple hundred for push handles for someone to move her around? And the smart drive power assist still requires she participate in propelling herself. So at any times when she's completely unable to propel herself at all, the push handles would be required for someone to assist her.

    It makes me so angry. She asked if the mistake with the chair being too wide (mis-measurements) was common. I said unfortunately, yes. Very common. If she hadn't been able to get the Icon approved, she'd have ended up with a completely useless chair, that any attempt to use would have been physically damaging. And in this case its because the dealer changed things after the OT measured her. Because the Icon she demoed was adjusted much smaller and fit well. Think about all the people that don't even have the opportunity to see an OT first
    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.

  6. #6
    Medicare does pay for push handles. DME is lying to cover negligence. She can justify them as positioning devices (depending on her level of SCI), as well as essential for caregivers. How DMEs can stay in business with this kind of service is crazy. Manufacturers should not allow representatives like these to handle their products, because of physical liability and how poorly it presents their product.

  7. #7
    DME has been cut so bad......they pay so little so you get this kind of help. People who don't give a dam get paid 12 hour.

    Try and get something fixed today......good luck with that.
    Art

  8. #8
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    Yes Medicare does pay for push handles. They must be made of the material Medicare is covering. From what you wrote, it sounds like the dealer is a real problem.

  9. #9
    Senior Member elarson's Avatar
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    It really sounds like the dealer screwed up. How dare they change an order without permission of the customer. It should be a requirement that the customer signs off on an order before it is sent in, not just the dealer! This must be so frustrating for her, not to mention time consuming, stressful and unsafe.

    Quote Originally Posted by ~Lin View Post
    Not to mention its totally NOT OK for the dealer to just make changes to the chair without having discussed them prior to the chair being ordered.
    I think getting the OT involved is a really good idea, along with insurance as you suggested. She should definitely not accept delivery of this chair until it meets her requirements as ordered. If she has not already done so, I think she should put in a formal written complaint to the DME with full documentation, and then possibly also to Medicare if they do not respond appropriately. See Complaints about durable medical equipment (DME), and note they must give a response in writing within 14 calendar days.

    She's going to email the OT about the problems and changes the dealer made from what was agreed upon. The chair was also supposed to come with a headrest and didn't. She's going to take photos so I can get a better idea of what parts are currently on the chair. And I told her she should contact insurance and tell them to not pay until this has been resolved, that the chair she has received is NOT the chair that was ordered.
    About the push handles, can she give a reason something like the SmartDrive can not be attached during bathroom ADL activities because of space or that she needs push handles for while the SmartDrive is being charged or if there is a power outtage?
    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. #10
    Senior Member ~Lin's Avatar
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    She has the chair right now. I think they rushed her along with delivery, she was talking to me while waiting for them to arrive. All excited about the delivery, then left when they got there. When she came back and messaged me about the problems I was surprised she was back so quickly. She didn't know what to do to advocate for herself further.
    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.

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