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Thread: New Manual chair through Medicare/Medicaid understanding available options for 2018

  1. #31
    wow that means it is going to be just as hard to get a chair as i thought! this sucks!
    T6 Incomplete due to a Spinal cord infarction July 2009

  2. #32
    Senior Member NW-Will's Avatar
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    Totally sucks.. and sucks all the energy out of you.. that you could be using for something positive...

    Quote Originally Posted by Smashms View Post
    wow that means it is going to be just as hard to get a chair as i thought! this sucks!

  3. #33
    Senior Member NW-Will's Avatar
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    Question hoping some one knows.

    Does a wheelchair count as something different to Medicare and Medicaid than other DME equipment?
    Just as far as procedure for buying obtaining etc. ?

    With some DME equipment the DME supplier tries to get pre-authorization for it.. and medicare denies it..and then you get a bunch of paperwork where you can appeal the medicare decision.
    Because I have Medicare/medicaid.. once medicare denies an item the DME supplier then submits the paper work to medicaid with the Medicare denial, again it may be denied and you may appeal to medicaid.
    Just from my experience, it seems like we just try to appeal medicaid, and so far in my experience after appeal with what ever paper work they require the item has been approved.. I admit this process can go on for 12 months but so far every item I've appealed mediaid has paid for.

    Getting a DME supplier to follow through on this process is a royal pain in the ass I admit, and I'm constantly phoning my doctor, medicaid and the DME supplier to see where the paperwork is held up.... 100% of the time it is the DME supplier. From faxing to the wrong place, to incorrectly filling out paperwork to not following procedure, to not filling documentation in a timely manner, super frustrating.

    Just wondering why the DME supplier won't go through this same procedure with a wheelchair ?

    I'm using different DME supplies for all different things.. and I'm only talking to this DME supplier about wheelchairs.

    Are wheelchairs automatically assigned as some kind of different equipment. ?

  4. #34
    Quote Originally Posted by NW-Will View Post
    Question hoping some one knows.

    Does a wheelchair count as something different to Medicare and Medicaid than other DME equipment?
    Just as far as procedure for buying obtaining etc. ?

    With some DME equipment the DME supplier tries to get pre-authorization for it.. and medicare denies it..and then you get a bunch of paperwork where you can appeal the medicare decision.
    Because I have Medicare/medicaid.. once medicare denies an item the DME supplier then submits the paper work to medicaid with the Medicare denial, again it may be denied and you may appeal to medicaid.
    Just from my experience, it seems like we just try to appeal medicaid, and so far in my experience after appeal with what ever paper work they require the item has been approved.. I admit this process can go on for 12 months but so far every item I've appealed mediaid has paid for.

    Getting a DME supplier to follow through on this process is a royal pain in the ass I admit, and I'm constantly phoning my doctor, medicaid and the DME supplier to see where the paperwork is held up.... 100% of the time it is the DME supplier. From faxing to the wrong place, to incorrectly filling out paperwork to not following procedure, to not filling documentation in a timely manner, super frustrating.

    Just wondering why the DME supplier won't go through this same procedure with a wheelchair ?

    I'm using different DME supplies for all different things.. and I'm only talking to this DME supplier about wheelchairs.

    Are wheelchairs automatically assigned as some kind of different equipment. ?
    I had medicaid/medicare with my last chair, and I think it works the way you describe.

    I currently have pointless secondary medicare right now, and my DME provider made me sign a form listing the items that medicare denies and I have to select whether to appeal their decision, or agree to pay and then appeal or just agree to pay for those items. I'm sure it depends on how good medicaid is in your state, but in mine they pretty much covered everything that medicare denied as long as I had the doc list a reason why I needed it.

  5. #35
    Senior Member NW-Will's Avatar
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    How long ago did you go through this?
    And which DME supplier did you use ?
    Seems like it's super hard to find a motivated DME supplier.


    Quote Originally Posted by funklab View Post
    I had medicaid/medicare with my last chair, and I think it works the way you describe.

    I currently have pointless secondary medicare right now, and my DME provider made me sign a form listing the items that medicare denies and I have to select whether to appeal their decision, or agree to pay and then appeal or just agree to pay for those items. I'm sure it depends on how good medicaid is in your state, but in mine they pretty much covered everything that medicare denied as long as I had the doc list a reason why I needed it.

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