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Thread: Finally gonna try to use Medicare to get a chair

  1. #51
    Senior Member Oddity's Avatar
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    TL;DR: I'm not against titanium, there is room for lots of materials, IMO, but the advantages of titanium alone remain untested, are based on marketing and anecdotes, while the additional cost is guaranteed. I question the value proposition more than the functionality

    Yeah, the Quickie Ti was insanely light. Titanium helped enable that but it was mostly design that achieved the result. Ti allowed the use of very skinny OD, very thin walled, tube, which was indeed light. It also flexed like crazy and some parts were engineered past the edge IMO (like the axle plates) and had higher than typical failure rates. It's all a balancing act. Titanium alloy can enable certain designs.

    Whether or not a titanium chair is lighter is an engineering outcome, not a solely a materials outcome. Light weight engineered titanium tubes have to be made thin, else they'd be heavier than identical aluminum tubes, and aren't any more durable as a result. It costs more, guaranteed, and any given chair isn't necessarily lighter than any other just because it's titanium. Weight (and durability) is mostly about accessories, hardware, and design. The lightest, strongest, chair I know of was made from chromolybendum steel. Damn cheap and very strong. But, I guess "Chromoly" just doesn't have the ring to it that "aerospace grade titanium" does.

    Quote Originally Posted by August West View Post
    Two big advantages with titanium are weight and no maintenance. I want to resurrect my Quickie Titanium because it is significantly lighter than anything else I ever used. Doesn't make any difference except for one thing. My shoulders feel the difference when transferring the chair in and out of the car. That's just one thing. But it's a biggie.
    Last edited by Oddity; 05-02-2019 at 09:42 AM.
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  2. #52
    Senior Member Hype62's Avatar
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    May 2000, T4-5 Complete.

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  3. #53
    Quote Originally Posted by Oddity View Post
    any given chair isn't necessarily lighter than any other just because it's titanium.
    I'm on board with everything else you're saying (and I'll freely admit my bias for titanium isn't fully rational), but if the manufacturer (such as TiLite) lists an aluminum version as 1.8 pounds heavier than the titanium version, surely titanium is necessarily lighter when comparing the two options.

  4. #54
    Senior Member Oddity's Avatar
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    Absolutely. Unassigned billing is handy. Risky, but handy.

    Things that can (I've witnessed) go wrong:


    - Claim denied because DME does not file correctly (on behalf of patient instead of themselves). Patient stuck with full cost paid up front and no help trying to recover reimbursement from Medicare (DME has their $ and didn't want to work for free to re-submit claim paperwork)

    - Chair comes with wrong specs/other problem. Again, like above, DME has zero skin in the game, having been paid in full up front. If you think DMEs are hard to deal with, when they stand to make some money off you, try working with them when they don't.

    - Claim is denied for some other reason. Patient stuck with full cost.


    Those are 3 occurrences I know of; 1st hand, but there are undoubtedly others. Most revolve around the patient having to pay entirely up front and getting stuck with either that cost, a chair that's not right, or BOTH, without much recourse.

    One small snag is an unassigned claim can only be billed at a 15% premium over the base reimbursement amount, which might not be enough additional $ to cover whatever margin the DME wanted in the first place. I'm only passingly familiar with the unassigned vs assigned rules so I'm going to do more research.


    Bottom line: I think it's worth pursuing to someone on Medicare, with plenty of cash on hand, must have titanium, and can manage the potential risks. To be clear, though: Unassigned Billing is a MUCH better deal for the DME! BUT, it can help patients who have cash, don't mind the premium, and can't/don't want to be bothered taking on filing the claim form themselves.


    Post Script line: For me, if I satisfied those conditions, it would be WAY easier just to pay up front, then file the claim myself. I'd save the 15% unassigned premium, the time waiting for DME to work up/submit the paperwork, and however good of deal the reimbursement is, into my pocket, would be based on however good of a deal I could negotiate, myself, with the DME, for the final chair price. I'd be in complete control of my own fate, spend less money, and get exactly what I wanted.

    Basically, If you're willing to learn how to file a claim yourself (if you can do your own taxes, then you're fine; it's not rocket science; it's just filling out a form correctly), then you can get whatever K0005 chair you want. Using "unassigned billing" is a half-way measure, IMO, that carries similar risks as self-filing, but costs a 15% premium. That premium could easily be worth it to some folks, though.

    Thanks for sharing the article! That kind of info is what makes this place so helpful.
    .
    Last edited by Oddity; 05-08-2019 at 09:15 AM. Reason: Words
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

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  5. #55
    Senior Member Oddity's Avatar
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    The way TiLite makes their chairs, absolutely. I can't imagine the business case for a company, named TILite, to make and market lighter aluminum chairs. Titanium is a heavier (but stronger) element than Aluminum. Widgets are made lighter by being made thinner than aluminum can be, while maintaining similar strength, with the thinner tube walls.

    So, what I meant was, unless the Ti is engineered to its strengths, it'll in fact be heavier (but stronger) than the same piece out of aluminum. That's a fact of atomic weight. When it is engineered to its strengths, a titanium widget CAN be made to be lighter than the same one made from naturally lighter aluminum, but then it's not necessarily stronger. It's all about the engineering potential of the material, not the material. Granted, it maintains its beneficial property of not micro-fracturing under stress, like aluminum, but whether that makes a difference in the expected lifetime of a wheelchair (5 years to TiLite) is unproven.

    Between brands, it's even less of a "sure thing". E.g. One buddy has a Top End Crossfire T7 (7000 series aluminum) that is a full 2lbs lighter than another's ZR. It cost 1/3 the price and has the same warranty. That's what I mean by "just because its titanium doesn't mean it is lighter" (or stronger).


    (Interesting aside: TiLite frame warranties are the same for aluminum as for titanium. If their titanium chairs were, in fact, stronger and more durable, you'd think they'd have assigned longer warranty periods to reflect that benefit to the consumer. They aren't.)

    (Another interesting aside: Do they make an identical ZR frame in aluminum? Is that even an option? If they're comparing their ZR to, say, their Aero Z, then is that even a relevant claim - beyond its marketing value? I dunno...)

    Ultimately, I like that titanium chairs are available. My next out of pocket chair is gonna be a HoC titanium, just because. I don't dislike it, I just don't revere it either. There is much hype and little data based evidence.


    Quote Originally Posted by funklab View Post
    I'm on board with everything else you're saying (and I'll freely admit my bias for titanium isn't fully rational), but if the manufacturer (such as TiLite) lists an aluminum version as 1.8 pounds heavier than the titanium version, surely titanium is necessarily lighter when comparing the two options.
    Last edited by Oddity; 05-08-2019 at 09:05 AM. Reason: Words
    "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

  6. #56
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    I am embarking on the process of getting a new chair through medicare. This thread is very helpful!

  7. #57
    Senior Member Oddity's Avatar
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    Let us know how it goes! I've been pleased with how easy it's been. One doctor's visit, one OT eval, one meeting with DME. Everything (except noted) approved first pass. (Including options I thought they'd balk at, like fixed backrest canes and Roho back.) As a T12 SCI patient, getting a decent new chair, in my area, using Medicare, wasn't much of a chore, at all. The professionals I partnered with, in the process, did very well for my interests, IMO.

    Quote Originally Posted by Tetracyclone View Post
    I am embarking on the process of getting a new chair through medicare. This thread is very helpful!
    "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

  8. #58
    Quote Originally Posted by Oddity View Post
    TL;DR: I'm not against titanium, there is room for lots of materials, IMO, but the advantages of titanium alone remain untested, are based on marketing and anecdotes, while the additional cost is guaranteed. I question the value proposition more than the functionality

    Yeah, the Quickie Ti was insanely light. Titanium helped enable that but it was mostly design that achieved the result. Ti allowed the use of very skinny OD, very thin walled, tube, which was indeed light. It also flexed like crazy and some parts were engineered past the edge IMO (like the axle plates) and had higher than typical failure rates. It's all a balancing act. Titanium alloy can enable certain designs.

    Whether or not a titanium chair is lighter is an engineering outcome, not a solely a materials outcome. Light weight engineered titanium tubes have to be made thin, else they'd be heavier than identical aluminum tubes, and aren't any more durable as a result. It costs more, guaranteed, and any given chair isn't necessarily lighter than any other just because it's titanium. Weight (and durability) is mostly about accessories, hardware, and design. The lightest, strongest, chair I know of was made from chromolybendum steel. Damn cheap and very strong. But, I guess "Chromoly" just doesn't have the ring to it that "aerospace grade titanium" does.
    While a titanium chair isn't necessarily lighter than an aluminum chair, it is easier to make it lighter with titanium than aluminum.

  9. #59
    Senior Member Oddity's Avatar
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    How so? It's harder to extract from the Earth. It's harder to process as ore. It's harder to manufacture into workable alloy materials (billets, tubes, etc). It's harder to fabricate with. It requires extra product engineering to overcome its ~60% heavier weight by volume vs aluminum. I wouldn't call it easier to do anything with titanium vs aluminum. All that "easier" adds up to ~3-4x the cost, even though it's one of the most abundant elements in the Earth. It costs so much precisely because of how much more difficult it is to work with, vs aluminum, up to, and including, making a lightweight wheelchair.
    "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

  10. #60
    Easier not in the sense of manufacturing challenges but in the sense of design possibility. Titanium has superior tensile strength, which enables using less material (less weight) for the same strength. In other words aluminum cracks before titanium cracks for the same weight so aluminum needs to be heavier for the same strength. I'm no materials guy so don't ask me for an engineering analysis. This is just my understanding.

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