I got amazing news on Xmas, my chair was approved by BCBS!
Today I got the breakdown of what was submitted/approved. DME put 2,500 of "upgrades" on prescription form for my Dr. to sign (convenient round number for ZRA upgrade, scissor locks, fenders, caster/wheels, Surge lt, vfront, open loop footrest, push handles, carbon back release bar). These weren't submitted individually, I was told I would need to pay the 2,500 quoted in upgrades because these pieces individually, if approved, insurance only reimburses _$ and I would be responsible for any additional amount. Insurance said that's ridiculous, entire chair/pieces should be submitted, that I have a very good plan and that was the point of the plan. I did my best to provide my DME with HCPCS codes other than K1080, the code he said didn't reimburse him enough. Is there a place Tilite lists these codes? I had to guess I had the right code on a few.
Am I being unreasonable asking for every piece to be submitted? What do DME's usually do when submitting? I have a PPO and just reached my out of pocket maximum. BCBS said everything approved would be covered 100%.
I purchased my last chair on my own, didn't go through DME so I'm not sure what's normal or not. Thank you for the help if you made it this far!