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Thread: Medicare doesn't cover wheels or sideguards or casters?

  1. #1

    Medicare doesn't cover wheels or sideguards or casters?

    Getting a chair is always complicated, and my annoying DME won't take my advice and let Medicare just deny the whole chair (I have private insurance, medicare is secondary and isn't going to pay anything anyway), but they sent me an "Advance Beneficiary Notice of Noncoverage" (ABN) stating that medicare would not pay for my wheels (I had requested XLX wheels) or the casters (Litespeed billet aluminum) or even aluminum sideguards?!?!?!?

    I kinda get the wheels and maybe the casters (though it's not like my DME suggested some wheels or casters medicare might cover), but sideguards?!?!? That's outrageous, they'll pay two orders of magnitude more for the hospitalization after I get a friction burn to both of my hips and end up in the hospital... Though I guess there's really little chance of my tires rubbing on my hips since they don't want to cover the wheels or casters either... If BCBS draws the same line I'll just order the chair without casters or wheels since I can buy both for cheaper than the DME wants to charge me online... I'd be tempted to scrape/drag myself into the insurance company's office on my wheeless/casterless "new" chair and complain that something just doesn't seem right about it.

  2. #2
    Yup, they denied my Dad's sideguards too. In theory, they are not there to protect your skin, as a well fit chair means your body doesn't touch the wheels. They are there to keep your clothes clean, which Medicare doesn't consider medically necessary. If Medicare wont cover gloves to keep your hands clean while you are doing digital stimulation and manual removal during your bowel program, they certainly wont pay for sideguards.

    When my Dad got his Tilite 10 years ago, similar to you he had Medicare and BCBS (private plan that would pay even if Medicare did not). He qualified for a power chair at that time and got a Tilite manual chair with eMotion power assist wheels. The funny thing was that Medicare paid for the Tilite chair, and paid for the eMotion wheels, but DENIED paying for the axel to connect the eMotion wheels to the chair. The axel was slightly upgraded.... stronger, to be able to accommodate the power wheels.... and there was no choice but to use that axel or you couldn't connect the wheels. So denying the axel was...nonsensical. But deny they did. I tried to appeal it twice, and they refused. Upgrades are not covered. Even if they are essential.

    I have no idea how Medicare thought he would be able to use a wheelchair where you were lacking the part to connect the wheels to the chair.

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