My DME (notorious liars and incompetents) are telling me that BCBS "denied" my upgrade to my chair.

Has anyone had BCBS or any other major private insurance company approve a titanium chair in the past couple years?

They're saying the disapproved the titanium upgrade and sideguards. This is my first chair with purely private insurance (I have medicare as secondary and beyond delaying this process about 12 months because of National Seating and Mobility's incredible incompetence, confusion and generally douchiness, I knew it wasn't going to contribute to the overall bottom line so I'm not using Medicare).

I was just in physical therapy for my shoulders, and I have to haul the chair in and out of the car multiple times a day which is the main thing aggravating my shoulders, surely if Titanium chairs EVER get approved mine would. Kinda weird that they don't approve sideguards, but whatever I'll just get the cheapest ones they have, I kind of want to see if I can get someone to fabricate some custom carbon fiber panels for the sidguards anyway.

They're trying to tell me my copay is a little over $3100 for a titanium TR, which seems a little steep, but I know there is some weirdness about an "allowable amount" rather than a straight up 20% copay. I'm still waiting on the horrible humans at the DME to do their thing and send me an itemized bill, which will undoubtedly be incorrect and require me to remind them of what I actually ordered. I called insurance, and all they can see is that a wheelchair cushion was approved, other than that the person I called didn't see any preauthorization for the chair, but I think if you have an "allowable amount" there is no such thing as preauthorization.


In addition, has anyone paid out of pocket (ie not through DME provider, but buying online or whatever) for wheelchair options? Depending on how they're calculating what I owe them it might be cheaper to order the chair without wheels and just buy the wheels online or buy the sideguards separately, etc, etc.

I figure with wheels it wouldn't be a big deal, as long as TiLite was still willing to mount the brakes at an appropriate position for 559 wheels, which is what I plan to purchase, but I'm kinda worried that I can't do this with the sideguards, because the side guard mount feels like it's drilled into the frame on my current ZR (but maybe that's not actually the case, I don't know if this can be added after the fact or not).


Being a cripple sucks. I learned long ago that you have to be your own physician, and I've got that one down fairly well, but now I have to also be my own DME and insurance billing specialist or I'll never get anything done.