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Thread: Is it possible how hard is it.. to get medicare to recognize a manual chair I go buy?

  1. #1
    Senior Member NW-Will's Avatar
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    Is it possible how hard is it.. to get medicare to recognize a manual chair I go buy?

    My suppliers method of attrition is wearing me down trying to get a new chair.

    The best line so far is... "we can refurbish your current chair"..... what kind of comedy is this?

    There must be some medicare code to refurbish chairs... what utter BS.

    So wondering if I just go out of pocket and buy the chair I need, how hard is it to get medicare to recognize it for maintenance purposes ?

    Just looking at an Invacare Topend Everyday(aluminium) ERGO terminator chair.

    Thanks

  2. #2
    Quote Originally Posted by NW-Will View Post
    My suppliers method of attrition is wearing me down trying to get a new chair.
    Quote Originally Posted by NW-Will View Post

    The best line so far is... "we can refurbish your current chair"..... what kind of comedy is this?

    There must be some medicare code to refurbish chairs... what utter BS.

    So wondering if I just go out of pocket and buy the chair I need, how hard is it to get medicare to recognize it for maintenance purposes ?

    Just looking at an Invacare Topend Everyday(aluminium) ERGO terminator chair.

    Thanks



    The standard is that Medicare will pay for a new wheelchair every 5 years.

    Within that time, Medicare will pay for new tires, caster tires and batteries (if a power chair).

    What does refurbish a chair mean? Other than the maintenance items sited above, Medicare makes a determination that a chair, after a certain age (usually 5 years) is too expensive to maintain and that an new chair is the better option.

    If this is the smoke your current durable medical equipment supplier is blowing at you...it is time to find another one.

  3. #3
    Medicare will not pay for any repairs to a chair they did not buy.... sorry.

  4. #4
    Senior Member Oddity's Avatar
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    Nor will they reimburse for any accessories you might want at a later date. This even includes replacement cushions. I needed a new cushion a while back and was denied and denied again upon appeal, the reason cited being they won't accessories a chair they didn't initially reimburse for and they consider a cushion an accessory.
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  5. #5
    Quote Originally Posted by Oddity View Post
    Nor will they reimburse for any accessories you might want at a later date. This even includes replacement cushions. I needed a new cushion a while back and was denied and denied again upon appeal, the reason cited being they won't accessories a chair they didn't initially reimburse for and they consider a cushion an accessory.
    This sounds like it means if you have private insurance buy a chair and then transition to Medicare they won't buy the cushion?

    So I guess you just need to get Medicare to buy an entire new chair so that you can get a cushion... right?

  6. #6
    Senior Member Oddity's Avatar
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    Quote Originally Posted by funklab View Post
    This sounds like it means if you have private insurance buy a chair and then transition to Medicare they won't buy the cushion?

    So I guess you just need to get Medicare to buy an entire new chair so that you can get a cushion... right?

    Exactly. But the good folks up at Woodrow Wilson Rehab in VA would not do that. They were looking out more for Medicare's budget than my needs. I haven't been back since. (This caused s big argument between a couple of PTs while I was there. One agreed with me the other didn't. The billing department decided it.)
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  7. #7
    A new wheelchair every 5 years is a covered Medicare benefit. If you can't get it covered, then something is wrong either with the way you are making your case or someone not hearing your case.

  8. #8
    Even if its less than 5 years, if your doctor says its medically necessary for ADL you can get it. You need to base all your augments on ADL. And generally stuff you do inside your home.

  9. #9
    Correct. Medicare only considers what you require for use/mobility inside your home. They clearly state that community mobility needs are not a covered DME benefit.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  10. #10
    Medicare has covered repairs/maintenance/cushions for my original chair which was purchased by private insurance while
    I was in acute rehab immediately post-injury.

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