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Thread: medicare/medicaid an manual chair?????

  1. #1

    medicare/medicaid an manual chair?????

    my dme called me...outta the blue, askin if i need any new equipment. i told him i was in dy'er need of a cushion. low an behold......i'm eligible for a cushion an new manual. guess i'll be hosting my new chair thread pretty soon, haha.

    i already know my measurements, etc, etc.

    just gettin my appointment with a PT tomorrow, so....... my question?????

    how advanced will medicare/medicaid go on a high-end chair? i mentioned...titanium, he said they'll go X amount of $$$$$ on ti. i'm assumin tilite EVO is about all they'll stretch on titanium. which i'm leanin towards ti from readin threads. EVO aint real appealing though.

    he mentioned that things would take forever, bein outta country, BUTT, if thats what i really wanted, he'd order it. i don't wanna go that long distance route anyways.

    anywho.....what will they pay for? considering.....invacare, quickie? top end terminator? quickie gt?

    want something nice/comfortable. i know....."DEMO" but i won't go.....A-4, GPV. like colours but 90 degree front don't agree with my legs/feet/spasms. gonna hafta get somewhere between 75/85, which might be *80*, hahaha.

    any helpage or knowledge bout ga. care/caid. i have both.

  2. #2
    i have a A-4 , i fixed my harley less.
    oh well

  3. #3
    colours can make any frt angle u want rep
    c4/5 inc funtioning c6. 28 yrs post.
    sponsored handcycle racer

  4. #4
    Quote Originally Posted by fuentejps
    colours can make any frt angle u want
    dunno if medicare/caid will pay for the extra cost though.

  5. #5
    nobody got a manual thru medicare/caid lately?

  6. #6
    Medicare allows (pretty sure) up to 2600 for a new chair (ultra light). I don't know if Medicaid will pick up the rest of the balance for a higher end chair though.

  7. #7
    If Medicaid is funding they will not allow you to pay for a differential- in their eyes, you should not have ANY extra money. In fact vendors cannot legally accept monies from medicaid clients for the purpose of paying a differential.
    Not fair- not reality but that is the game of Medicaid.

    Medicare does allow for one to pay a differential, and vendors can go so far as vend equipment and make clients sign an ABN (I think that is the form name), which makes the end user responsible if at any time Medicare arbitrarily decides not to pay for a piece of equipment recommended, needed or wanted but questionable for reimbursement. And the ridiculous part of this policy is that it may be a lack of a signature, a misdated prescription/evaluation etc, and Medicare can deny payment. In essence holding the vendor or end user hostage. (Can you tell that I am bitter over Medicare?)

    In the end it all will depend upon your primary finder as to how this can be handled. Neither is ideal in the respect that neither providers has the end user in mind. It is strictly about the bottom line, and not the the bottom so to speak. Hope this helps.
    Pam OTR/L

  8. #8
    i've been browsin thru spinlife, they have the green "M" on the chairs that are medicare eligible.

    not sure if medicaid will be involved or not. i'm not wantin to pay extra, i'll be happy with whatever they pay for but i want to get the best i can get, not just the cheapest.

    can't see the PT for a couple weeks from now so i got time to figure things out. if medicare will only pay $2600 an i get a chair that costs $2500, that only leaves my DME provider making 100 bucks. how are they gonna go for that?

  9. #9
    2600 is what Medicare will allow, but not necessarily what your DME provider will pay for the chair. They (DME provider) get the chairs at wholesale prices, then sell them for much much more. Looking for a chair for the whole 2600 will make no difference when it comes to their (your DME's) profit. Don't worry about that, they know what they are doing and they know how to make money. But...there still is the 20% copay that is up to you to pay (Medicare only). So, for a chair that cost 2600, that means you pay 520 out of pocket. You may also want to take that into consideration before buying......unless you have a secondary insurer who will pay the difference.

  10. #10
    okay, i guess thats where medicaid kicks in (payin the other 20%). i wasn't thinkin bout em gettin them wholesale. i know on sportaid they're wayyyyy cheaper than on the manufacturers website. tis makin more sense now.

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