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  1. #1

    Insurance and wheels

    So my DME (a new one after two years of failures with incompetence from NSM) who I'm getting a new TRA through tells me that insurance will not cover XLX wheels.

    Well... actually he tells me they will cover any wheels I want, but only at a "contracted rate" of $178 which they are not allowed to balance bill me for, so they won't move forward with the order for any wheels other than the default free option wheels... which feels very... not true to me.

    Apparently insurance (Cigna through my employer) WILL cover a titanium upgrade and glide suspension forks, but will not cover any wheels beyond what $178 will get you, which is apparently the stock sunrims or whatever plastic garbage comes default from Tilite these days.

    Also he says with my current specs: 90 degree front angle 18" depth, 13" width and I don't quite remember the front height, but it's something like 17 or 18" that frog legs front forks with "interfere with the rear wheels"... WTF? It's very similar specs to the chair I'm sitting in right now, and there is 6" of clearance between the casters and the rear wheels measuring the nearest I can possibly swing the casters... Are frog leg forks really some absurd monstrosity that adds an additional 6" to the rearward swing of the casters? It has to be even more than that because I'm going with a smaller rear wheel (559 from my current 590s) and they tell me they would have to extend the frame an extra 2.25" forward for the casters/forks to clear the rear wheels. I could totally see the scenario where the frog legs might interfere with the footrest, my current casters hit the sides of my shoes all the time when they turn inwards, but he clearly said they need to add 2.25" of frame depth in addition to my already 18" deep seat depth in order for them to clear the rear wheels which would do absolutely nothing if he had accidentally misspoke and meant the clearance of the footrest. Comparing it to my current chair, he is saying the center of axis of the casters needs 9" (clearance on current chair) plus 2.25" (requested additional length) plus about 0.5" for the smaller wheels, which means some part of the casters must swing in a 1 foot radius arc from the center of the fork... I mean they would interfere with EACH OTHER before they would interfere with the rear wheels, nevermind a place for me feet to sit between the casters, with my current chair the center of the casters is only 17" wide. I guess I need to call Tilite and clarify what they mean by this because I can't picture it.

    Has anyone run into insurance not covering rear wheels at all (beyond the stock option)?

    Also does anyone have a chair with an 18" depth and a reasonably narrow width with suspension forks that they could take a picture of? Maybe they're super longer than I was thinking in which case it definitely wouldn't work.

  2. #2
    Bumping to see if anyone (Medicare or private insurance) has been told insurance does not cover anything but the bare bones stock wheels. Even back when I had medicare/medicaid they covered Spinergy LX's and my insurance is (supposedly) approving a titanium upgrade but allowing only $178 for wheels.

    Maybe the standard rules have changed drastically and all yall are paying out of pocket for those round betty's and Spox and whatnot... but I kind of doubt that.

  3. #3
    I have Washington State Labor and Industries Insurance. They've bought me exercise equipment, over a dozen handcycles, countless chairs in the 44 years post injury. But, they will not buy Spinergy or other "fancy" wheels. they did in the early days or my DME, a good friend, buried it in the cost somehow.

  4. #4
    Also just got off the phone with my insurance company who says I have $5,000 in DME coverage and that's it for everything. So I might be buying the wheels and some other things out of pocket. Certainly can't get an smart drive... at least not this year.

  5. #5
    No problems with upgrading wheels. But I guess it depends on the reason. Some are way too heavy for my bad shoulders. The DME makes less money and does more work for this type of chair than a power chair. Not all DMEs want to put in the effort. One told me so outright. But it could be your insurance. Either way, if you keep at them, I think you will get what you need. You just have to be persistent. It took me over 2 years, going onto 3 years, to get my chair order the way I need it.

  6. #6
    No way an 18" seat depth will result in the casters interfering with the wheels. But a 13" width may result in the casters interfering with your feet. I recall that problem with a 15" width.

    More important is combining minimal depth with minimal width may result in problems with stability. That may be the reason for the change TiLite wants but the DME is not communicating correctly.

  7. #7
    Quote Originally Posted by August West View Post
    No way an 18" seat depth will result in the casters interfering with the wheels. But a 13" width may result in the casters interfering with your feet. I recall that problem with a 15" width.

    More important is combining minimal depth with minimal width may result in problems with stability. That may be the reason for the change TiLite wants but the DME is not communicating correctly.
    yeah I too assumed the casters could be interfering with the footrest or the area where my feet go because of the width, but one of the solutions they offered was lengthening the frame by 2 inches which wouldnt change that distance at all.

  8. #8
    Senior Member Oddity's Avatar
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    Quote Originally Posted by funklab View Post
    yeah I too assumed the casters could be interfering with the footrest or the area where my feet go because of the width, but one of the solutions they offered was lengthening the frame by 2 inches which wouldnt change that distance at all.

    If you haven't already, I'd get a copy of the exact order form they sent in and the CAD drawing. Hard to trust a DME, entirely. So many are so dumb. I found several careless mistakes on my order form, which would have led to much whinging from me has the time come to get the chair and I'd not triple checked everything the DumbME had done.
    "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

  9. #9
    Quote Originally Posted by Oddity View Post
    If you haven't already, I'd get a copy of the exact order form they sent in and the CAD drawing. Hard to trust a DME, entirely. So many are so dumb. I found several careless mistakes on my order form, which would have led to much whinging from me has the time come to get the chair and I'd not triple checked everything the DumbME had done.
    Do they still do CAD drawings?

    I seem to remember people on here saying they were told it just isn't possible any more (or there is a charge for it or something). My last DME (who I just switched from) had multiple mistakes on their order form, so I plan to do this, but I don't think I'm there just yet.

  10. #10
    Senior Member Oddity's Avatar
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    Yeah, they still do it. One freebie. If your DME has sent an order form, it's safe to assume they got a CaD response with notes on the concerns in the margin. That is how mine came.

    Quote Originally Posted by funklab View Post
    Do they still do CAD drawings?

    I seem to remember people on here saying they were told it just isn't possible any more (or there is a charge for it or something). My last DME (who I just switched from) had multiple mistakes on their order form, so I plan to do this, but I don't think I'm there just yet.
    Last edited by Oddity; 04-17-2019 at 03:05 PM.
    "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

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