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Thread: will medicare/medicaid pay a downgrade from power chair to manual?

  1. #1

    Question will medicare/medicaid pay a downgrade from power chair to manual?

    i didn't want to hijack rollin64s thread thread so i started this one. mom (raven) has been having some problems with getting a new chair. about a month ago or so her old manual chair finally gave out. now, she's had that chair for i'd say over ten years approximately. about 4 & a half years ago or so it was time for a new chair. mom had asked for a tilite and the vendor had informed her that they weren't manufacturing them any longer. they gave her a scooter type hover-round deal to use. through and internet search she found out that they obviously did and still do manufacture those. she called them back and told them she didn't want it(the scooter thing). at that point they brought her a Quikie motorized chair. mom accepted it, thinkin it would help take some stress of the usage of her shoulders, etc. turns out that she couldn't use it around the house at all. it pretty much made everything around the house unaccessable to her, whereas when she had the manual chair it was easier. she wound up continuing to use the older manual chair until, well it finally went out on her.

    she's gotten the prescription from her doctor specifically requesting a manual chair. we have gone to atleast three vendors who have all pretty much told us the same thing. Medicaid/medicare (im not sure which is which?) will not pay for a "downgrade" from a power chair to a manual chair. apparently (or so we've been told) it's like saying that she is getting "better" ??? because apparently she's not supposed to do that i guess.

    after reading rollin64s thread where he is talking about getting some type of manual chair and stated that he had had a power chair previously, we were kinda wondering if this is something that is only in Texas? where medicaid/medicare says no? or is it that the vendors around here would rather her buy a power chair than something cheaper like a manual chair?
    is this a bunch of crap from the vendors or does this vary from state to state?

    mom has been having ALOT of problems with this power chair around the house. the little accelarator deal can be turned down all the way, yet when she slightly touches the little joystick thing it takes off fast. similair to a car when it's idle is way to high. she's not very picky and not really one to complain but she's been having ALOT of problems with this. the house was modified to be "wheelchair accessible" yet she's still having issues. it's bad enough to the point now that the other day she was making a turn around her bed and somehow hit her dresser with her foot because the accellaration on this chair is so fast. her right ankle are is swollen and well to make a short story long it's becoming more and more of a problem. if anyone knows of any information, it would be very very much appreciated. thanks in advance

    <3 DiScOrD
    Last edited by 1010011010; 08-11-2007 at 10:09 PM.

  2. #2
    Senior Member
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    ThAt acceleration can be turned down, but requires a pogrammer. The DME can do it.

    My chair has 4 drive gears, and each can be set up for speed accel, turn speed, and decelertion.

    Make the DME fix it.

    Other than that i'm Canadian so i'm clueless eh!

  3. #3
    Senior Member Broknwing's Avatar
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    Nick-
    As I understand it(although I do not have Medicaid myself so I haven't dealt personally) They can & will provide a manual chair as a "secondary" chair if you are in a power chair. At least this is what I've seen with friends in FL. IMHO the DME's are trying to get the biggest ammt of money out of you/her as they can...they are not looking out for her best interest or needs...They haven't tried/failed/appealed/etc to know that they won't pay. She definately will need a letter of medical necesity for the manual chair and it will definately need to say that she needs the chair for use at home. It's not that she's "getting better" but that the equipment that she was provided is not appropriate and safe for her in her home. You will either have to fight with the DME or find one willing to submit the claim...I don't know if you've tried everyone in town, but if you have you may need to seek out of town advice...I know it's a PITA and you have a lot on your plate but it may be the only way...

    In regards to her ankle, have you had it x-rayed? she may have fractured it when she hit the dresser...If it's still swollen she should have it looked at as soon as possible.

    Give your mom hugs for me...Love ya Raven!
    'Chelle
    L-1 inc 11/24/03

    "My Give-a-Damn's Busted"......

  4. #4
    thanks very much patonb and chelle for your responses.
    chelle is it medicaid that will pay in florida?
    so that we can try here, since the DME say that medicare won't pay.

  5. #5
    we have the same dilema. they got me a power chair an it didn't solve all my problems like i thought it would, lol. so it's collecting dust an i been using my manual.

    anyhow....my dme says they'll do it, most likely. he hasn't been wrong yet. well....except for choosing my chairs, haha. he told me to get a dr's script an letter of medical nessicity. met with me an the pt. he's sending it in and said it shouldn't be a problem.

    i guess ya just have to find a dme thats good at writing everything up. they need to tell them that the power chair isn't meeting your mobility needs and a manual would be more appropriate. GOOD luck....

  6. #6
    thanks to everyone for the replies. it's been alot of help. we're gonna try and see if we can get her a manual chair. with the new problem mom is having with her leg now because of this chair issue, it is just making it more urgent that she needs a manual atleast for around the house.
    rollin64 thanks for your reply and i hope you don't run into the same issue my mom has been having.

  7. #7
    good luck to yall as well. i know medicare/caid is a pain our arse. just keep tryin. if you can find a good dme/doctor combination i'm sure she can get approved.

    my dme got the doctor recommendation going. they say ya have to meet with a PT, which took another month. now waiting on approval, which will take about a month of nail biting, lol. then getting the chair ordered, which is another month. it's a bitch bein stuck under these conditions but what can we do?

  8. #8
    Senior Member Hype62's Avatar
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    Not sure about medicare, but I know medicaid can take up to half a year from when the process started to when you get your new chair. My friend got a new tilite aluminum manual chair through medicaid; he started the doctor's prescription process last november and got the chair finally in June. My very first quickie chair that I got 7 years ago through Medicaid took just as long too. Gotta love the slow pace of these government programs. Just gotta have patience for these kind of things.
    May 2000, T4-5 Complete.

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  9. #9
    Senior Member wheeliegirl's Avatar
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    I'd like to ask an unrelated question...... Are the DME's supposed to write everything up and get the seating eval, etc? I had to do all that myself when I was in the process of getting my current chair. Now I'm getting ready to ask for another chair, and was just wondering if I was adding unwarranted frustration to my life.

    I got:
    1) Letter from my primary physician (which I typed up myself and he signed)
    2) Letter from my physiatrist
    a) Evalution from a physical therapist

    The above professionals faxed or mailed their documents to the DME, who submitted the forms to Aetna. I was turned down at first, and this is where my memory slips me, I can't remember what I did to get them to finally approve the chair.

    Are the above steps usually handled by the DME? Or was I right to do the steps myself? I remember the whole thing took about 4 months.

  10. #10

    What a difference an insurer makes...

    Quote Originally Posted by wheeliegirl
    I'd like to ask an unrelated question...... Are the DME's supposed to write everything up and get the seating eval, etc? .
    I suppose it depends on your insurance. I am amazed at what some of you have to go through to get a chair and the length of time it takes.

    I am on MediCare and opted to go with Kaiser Senior Advantage (as I had already had Kaiser through my employer). I just got fed up last month with the difficulty I was having getting around and called my doctor and asked if he would look into the possibility of my getting a power chair. That was about the 15th of last month. My chair, an Invacare TDK SP, was delivered yesterday.

    I'm still in shock.

    My only complaint: It is rally green with canary yellow accents! Those are Oakland A's colors and I'm a Giants fan!

    Don't mean to make light of the difficulties some people have. I just want to point out the absurdity of our system. If I can get a chair that easily, why shouldn't others who desperately need a chair get one as easily?
    Bartski,
    San Francisco
    (Somebody wake me up!)

    "The darkest places in hell are reserved for those who maintain their neutrality in times of moral crisis."
    Dante


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