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Thread: Medicare and push handles?

  1. #11
    Senior Member elarson's Avatar
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    I find it very sad when DME's treat people like this. I hope you friend reads these posts also. Knowledge is so important, because the reality is that most people using complex rehab technology need to fight hard to get what they need.
    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).

  2. #12
    I think it's critical that the OT gets involved. In fact, your friend really should talk to the OT and arrange an appointment for OT to review friend in the chair, as well as help deal with the vendor.
    This requires prompt action, as vendor may try to avoid situation.
    If your friend is unable to advocate independently, your help as well as the OT, and maybe even ICON, will help resolve the problems.

  3. #13
    Actually, we were also told Medicare does deny push handles, and my father also had them denied. We appealed twice after they were denied (other things were denied as well) and lost. If the other posters know that Medicare does cover push handles, then hopefully they can post what needs to be documented so that they will get covered.

    It is very common for DME's to not order components when they suspect that Medicare will deny them, so this doesn't surprise me. To some degree you can't blame them as they are worried they will not get paid. But it is not acceptable for them not to explain they are not going to order them, or to not offer you the option of signing an ABN. My Dad's DME was AWFUL and they were only willing to order push handles because we signed an ABN (advanced beneficiary notice) saying that we would pay out of pocket for anything Medicare denied. Fortunately, his secondary insurance actually picked up the cost in the end.

    There were crazy things that Medicare denied on my Dad's wheelchair that don't make sense. They paid for his Tilite frame, and his Power Assist eMotion wheels, but they denied the upgrade to the axel that was necessary so that the wheels would fit safely on the frame. Totally irrational. Again - we appealed it TWICE (this took almost a year), and lost. It is what it is....

    What stinks is that it is usually cheaper to buy components on your own online rather than through the DME if you know they are going to be denied. But if there is a CHANCE they might be covered by Medicare and you want to have the DME give a claim a try. It is a risk.... that you may have to pay for. It frustrates me to no end.

  4. #14
    Medicare is getting worse if you read the next thread on this Forum:

    http://sci.rutgers.edu/forum/showthr...hnology-in-USA
    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/

  5. #15
    Senior Member elarson's Avatar
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    Where I live in the Netherlands you have a choice to fund equipment similar to how Medicare works or you can get a budget and make your own decisions. It's a lot of work and takes a long time to get approved, but once you get approval on a budget based on requirements, you can choose where and how you want to use the budget. It's even worse in Europe for mark-up on equipment, and by purchasing much of it online in the US, even with shipping we were able to save 40-50%, which allowed us to go for upgrades on everything and have spares. Although it has it's problems, like less than informed "advisors" who determine the budget, it's a good way to go for people who know what they need and how to get it, and makes for a more competitive environment. I think it's a shame that Medicare does not consider this option, because it would probably serve both the customers and taxpayers well.

    N.B. It also funded the seat base that the less than competent advisor forgot to include

    Quote Originally Posted by hlh View Post
    What stinks is that it is usually cheaper to buy components on your own online rather than through the DME if you know they are going to be denied. But if there is a CHANCE they might be covered by Medicare and you want to have the DME give a claim a try. It is a risk.... that you may have to pay for. It frustrates me to no end.
    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).

  6. #16
    You need to go back to her doctor and get a letter of medical necessity. Should be fairly straight forward when you tell him/her your friend can't bend forward to get dressed, because they don't have the handles to hold on to.

  7. #17
    Senior Member ~Lin's Avatar
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    She has the link to this thread so she can follow along, and I asked to make sure I had everything in the OP right. I said if she has anything she wants me to say here to let me know.
    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.

  8. #18
    Wait, does this mean Medicare COVERED AN ICON!?!?!?!?!?
    Please let me know if this is the case because I can still get ahold of my DME and change my chair order. I'd love to have an Icon, DME told me straight up Medicare doesn't cover it.

  9. #19
    Quote Originally Posted by funklab View Post
    Wait, does this mean Medicare COVERED AN ICON!?!?!?!?!?
    Please let me know if this is the case because I can still get ahold of my DME and change my chair order. I'd love to have an Icon, DME told me straight up Medicare doesn't cover it.
    On 12/01/2012, JeffAdams posted:

    " The Icon is coded as a K0005, and available through Medicare, and there are a number of additional allowable codes that apply to the Icon, which brings the total reimbursed amount up (adjustable angle back, solid seat etc).
    If you look at our online order form, all the HCPCS codes that apply to the options are listed on the order form.
    We work with the dealers on an ad-hoc basis to make it work in the Medicare funding model.
    Feel free to PM me at jeff@iconwheelchairs.com, or call on the toll free number 888-461-5759 if you want to discuss."

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