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Thread: Permobil Purchasing Problems

  1. #1

    Question Permobil Purchasing Problems

    Hi all,

    I've been a longtime Permobil Vertical Stander user from the Chairman C2K (purchased by ChampVA/Champus in '03) to a C500 (also purchased by ChampVA/Champus in '09). I am not a Veteran, I am receiving benefits through my deceased father who was a Vietnam Vet. Both prior Permobils were denied by medicare and paid in full, thanks to ChampVA.

    My last C500VS has been dead for the past 11 months. When we started the evaluation/order process back in June my dealer's estimate for the last generation of C500VS) came out to $51,652.95. My Dealer added some nice, but costly packages: "High speed base" (a $979 option over the standard speed base) and the Permobil Light Kit for $1,083. Do you think my dealer should have consulted me before submitting the quote to Medicare Champus? Because of that $51,000+ price tag it was denied. to emphasizes my need for this wheelchair I involved a congressional caseworker and hopefully light some fire under the VA.

    My regional Permobil sales rep. & congressional finally reached a deal with the VA to pay for a demo C500VS (latest generation before the product line cutoff) Now the VA wants me to appeal Medicare's denial. My dealer received (in their words) "seems to be a denial, but my Physical Therapist and I agreed too it was a denial. When I last spoke to my dealer they told me, "their is nothing to appeal, its just something they (Medicare) don't cover. Out of the Medicare handbook my dealer told me this, "VI. Group 4 PWCs (K0868-K0886) have added capabilities that are not needed for use in the home. Therefore, if these wheelchairs are provided they will be denied as not reasonable and necessary." (from the Noridian Healthcare Solutions, Medicare Jurisdiction Part D). Do you think the funds can be pulled from one of two avenues we are pursuing, (1) an appeal of ChampVA's denial or (2) a congressional funding request?

    I know I am asking a lot in opinion I am just a young adult college student on the break of loosing his sanity, lol.

    Thanks in advance

  2. #2
    I'm sorry I'm not that familiar with VA insurance. Maybe someone here can respond.
    However a few comments come to mind: if the VA wants you to do an appeal to Medicare I thinks that's reasonable. Pretty sure there's always an appeal process, so I don't agree with dealer that 'there is nothing to appeal....'. Would such an appeal hold up the VA decision to pay for a demo? Does the demo have the nice but costly add-ons that yes, the dealer should have discussed with you for sure.
    Did Medicare turn the purchase down due to these add-ons? If so it seems an appeal should address this - that the dealer added them on and you want to submit it for appeal without the add-ons. You may have to submit a new request to Medicare minus the extras if you don't need them.

    I once went through a sticky problem with Medicare when I needed a Permobile power chair - it was a demo with a power seat that raised and lowered. I didn't need the power seat and had to pay $3000 of the $9000 price of the chair. Funny thing...I ended up using the power seat every day for transfers. (No longer need this chair but saving it for future use).

  3. #3
    Thanks triumph, I will see if I can dig up that (seemingly) Medicare denial and try to appeal it!

  4. #4
    Thanks triumph, I will see if I can dig up that (seemingly) Medicare denial and try to appeal it!

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