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Thread: New Insurance Question

  1. #11
    Quote Originally Posted by fuentejps View Post
    It all comes down to lmn, write it yourself then ask doc to sign. I never use a pt just my sci doc.
    Have you purchased a chair using Medicare? I just completed the process and here are the hoops you have to jump through.

    Medicare requires that your doctor write an order for you to see an occupation or physical therapist for an evaluation for a wheelchair. The doctor must also provide the therapist and Medicare with clinical notes that support the need for a manual or power wheelchair.

    The physical or occupational therapist does an examination, asks questions about your abilities and other physical issues. During this evaluation, you may be pressure mapped for a new cushion, especially if the type you have been using isn't working for you. During this evaluation, the therapist will invite a durable medical supplier representative, with whom he/she regular works. That representative will bring a couple of sample chairs to the evaluation to get a sense of your needs.

    The therapist writes a summary of your physical requirement and a prescription for the type of chair and particular features you require. The evaluation summary and prescription must be signed by your doctor and returned to the therapist and the supplier. You are not required to use the supplier who attended yout evaluation. Whatever supplier you choose then works with you to get a chair that will serve your needs, orders the chair, delivers it, and makes any adjustments necessary.

    It is a long drawn out process and more and more insurance companies are adopting the Medicare model. The first physical therapist I called for the wheelchair and seating evaluation did not have any appointments available for 4 months. I was fortunate and got an appointment with another therapy group in one month. The process can take 2 to 6+ months before you actually have a chair delivered to you.

  2. #12
    no, but we are discussing private ins not medicare. I've never went through anything like you described with private ins. I complete the order form, review with dme, they get quote from mfr and then submit for approval with lmn. then wait for approval. I think the dme is where things go south.........
    Quote Originally Posted by gjnl View Post
    Have you purchased a chair using Medicare? I just completed the process and here are the hoops you have to jump through.

    Medicare requires that your doctor write an order for you to see an occupation or physical therapist for an evaluation for a wheelchair. The doctor must also provide the therapist and Medicare with clinical notes that support the need for a manual or power wheelchair.

    The physical or occupational therapist does an examination, asks questions about your abilities and other physical issues. During this evaluation, you may be pressure mapped for a new cushion, especially if the type you have been using isn't working for you. During this evaluation, the therapist will invite a durable medical supplier representative, with whom he/she regular works. That representative will bring a couple of sample chairs to the evaluation to get a sense of your needs.

    The therapist writes a summary of your physical requirement and a prescription for the type of chair and particular features you require. The evaluation summary and prescription must be signed by your doctor and returned to the therapist and the supplier. You are not required to use the supplier who attended yout evaluation. Whatever supplier you choose then works with you to get a chair that will serve your needs, orders the chair, delivers it, and makes any adjustments necessary.

    It is a long drawn out process and more and more insurance companies are adopting the Medicare model. The first physical therapist I called for the wheelchair and seating evaluation did not have any appointments available for 4 months. I was fortunate and got an appointment with another therapy group in one month. The process can take 2 to 6+ months before you actually have a chair delivered to you.
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