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Thread: What happens in a wheelchair evluation?

  1. #1

    What happens in a wheelchair evluation?

    Hi everyone, I'm new here so I'm not sure if I'm posting this in the right place, sorry if it needs to be in a different forum just let me know!

    I was wondering if someone could tell me what happens in a wheelchair Evaluation, I have new insurance this year and my doctor wrote a prescription for a new chair for me, a few days later I received a call from his nurse letting me know the insurance requires I go to a wheelchair evaluation with a physical therapist and that a medical equipment supplier needed to be there as well as myself and a family member.

    When I got my current chair (my first and only chair thus far) I wasn't measured or asked any questions or anything of that nature I just spoke with a medical equipment supplier that my insurance covered and was told what chair I would be getting and that was that. It's been less than two years since I received that chair (a quickie 2 folding chair) but my condition has worsened and now I need to use my wheelchair more and it doesn't fit me in size (it's large, heavy and I cannot load it in a car myself) and since no measurements were done it doesn't even fit through the doorways and hallways in my home (because when I got it, I didn't need it all the time and didn't need it in my home just for outside the house). Now that I need to use the chair daily in and outside of my home my doctor said I needed to get something else that would fit my daily life, however with new insurance it seems they are doing this a lot differently than my previous insurance.

    I go to the Evaluation on Tuesday, my doctor didn't tell me what would be happening durning this appointment and the hospital said they'd call to talk more about it on Monday so I'm sure they will tell me what to expect then but I was just wondering if anyone here could tell me what happens at a wheelchair evaluation and is that when you actually order a wheelchair since they told me the medical equipment supplier would have to be there too?

  2. #2
    For my wheelchair evaluation I had a PT, OT and a seating specialist from the DME. They measured me, checked strength and range of motion. Asked lots of questions and measured the scoliosis angle of my back. It took about an hour to do the whole evaluation. They asked me questions about pain and such too.

  3. #3
    You will get measured for a chair. A physical therapist will evaluate you in your old chair and make recommendations for a new one. There will probably be a DME supplier rep there to recommend chairs to you as well. If you're lucky you might get to try out a chair or two (though the sample chairs are generally not going to be the right size for you this isn't of much use).

    Make sure you tell them EVERYTHING you need for your chair. And if you want something for your chair, make sure you think of a good reason why you NEED it - i.e. I'm a fit para in his mid 30s, but I NEED light weight Spinergy wheels because my "shoulders hurt" not because it's easy to clean with fewer spokes and they're a bit more stylish than the garbage stock Sun Rims.

    I'm sure someone else will chime in with more advice, but in the next week you need to figure out exactly what you want out of a chair and make that case during your evaluation.

    Things that I assume you will need off the bat:
    1. A rigid ultralight chair - ultralight because you're too weak to push very far. Maybe you want a folding chair (I hear people like those but can't fathom why).
    2. Nice wheels - because they make it easier to push.
    3. A really good cushion, preferably pressure mapped - because we don't want any pressure sores and you're too weak to do proper pressure relief.

    Think of what other stuff you might want/need - brakes (and specifically what kind), solid back, solid seat pan, antitips (if you need them), fendered carbon fiber sideguards.

    You've got lots of research to do. If they get you a chair that fits and your condition doesn't worsen this might be the last chair you get for a long, long time, make sure it's exactly what you want.

  4. #4
    Thanks for the info guys! I am in the process of doing lot of research, I've been reading on the forum for awhile so I can try to know what kind of things I'll be needing in a new chair.

    I'm a previous cancer patient (osteosarcoma right humerus) I have limited mobility/strength with my right arm due to that, but I do still want a manual chair not a power chair. I've been recommend a ridgid chair because it would be easier and lighter weight for me the maneuver and also to load and unload in a car. I know lighter weight wheels will be something that I would like if possible and due to issues with my arm hopefully I can get those and some handrims that will help with pushing as well. I currently have a gel cushion and like it but I'm open to the therapist suggesting something else if they think I need it, so I'll go with their reccomendation on that. Everything else I'm still researching, but I appreciate all the info I'm finding here!

  5. #5
    as far as cushion i went with a roho quadttro i love it.
    T6 Incomplete due to a Spinal cord infarction July 2009

  6. #6
    Terminology is vitally important: specifically the difference between "lightweight" and "ultralight." Those terms mean very specific things to insurance companies: the are coded differently. They are defined in the Medicare HCPCS system, which doctors don't typically know, but PTs who spec wheelchairs do.

    "Ultralight" chairs are coded K0005; that's the code you need because K0005 chairs are intended for people who need a chair forever. "Lightweight" chairs are for temporary use (e.g., broken leg, difficult pregnancy, etc.).

    DMEs prefer to order lightweight chairs because the ordering process is so much simpler (aka more profitable) than it is for Ultralight chairs. Lightweight chairs are off-the-shelf products; Ultralight chairs can be off-the-shelf simple, one-off (i.e., fully custom made for the user), or anything in between.

    My chair is one-off - see pics in my signature. (I started with an adjustable ultralight (TiLite AeroZ), adjusted/modified it to fit me perfectly, then my PT used its configuration to order my one-off TiLite TR.) (Note: TiLite calls their one-off chair process TiFit.)
    Attached Images Attached Images  
    Chas
    TiLite TR3
    Dual-Axle TR3 with RioMobility DragonFly
    I am a person with mild/moderate hexaparesis (impaired movement in 4 limbs, head, & torso) caused by RRMS w/TM C7&T7 incomplete.

    "I know you think you understand what you thought I said, but what I don't think you realize is that what you heard is not what I meant."
    <
    UNKNOWN AUTHOR>

  7. #7
    Quote Originally Posted by chasmengr View Post
    Terminology is vitally important: specifically the difference between "lightweight" and "ultralight." Those terms mean very specific things to insurance companies: the are coded differently. They are defined in the Medicare HCPCS system, which doctors don't typically know, but PTs who spec wheelchairs do.

    "Ultralight" chairs are coded K0005; that's the code you need because K0005 chairs are intended for people who need a chair forever. "Lightweight" chairs are for temporary use (e.g., broken leg, difficult pregnancy, etc.).

    DMEs prefer to order lightweight chairs because the ordering process is so much simpler (aka more profitable) than it is for Ultralight chairs. Lightweight chairs are off-the-shelf products; Ultralight chairs can be off-the-shelf simple, one-off (i.e., fully custom made for the user), or anything in between.
    Thank you so much for that info, I made sure to write down a note in my paperwork that I'm taking with me to the appointment so I use the right terminology to get what I want and need. I for sure want the ultralight weight chair because I'm pretty sure what I currently have it probably considered the lightweight chair like you described and it is not meeting my needs so I don't want something like it again.

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