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Question re: insurance coverage of motorized wheelchairs (in the U.S.)

Discussion in 'Finances, Work, and Disability' started by Gingergrrl, Mar 26, 2016.

  1. Gingergrrl

    Gingergrrl Senior Member

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    After much investigation and going to a medical supply store in person this morning, I learned that Medicare and all private insurances in the U.S. will only authorize a motorized wheelchair if a person is completely paralyzed or 100% bed-bound. If they can stand and even walk 2-3 steps, it will not be covered.

    The Medical Supply store told me that Medicare sets this guideline (and then all the other insurance companies must legally follow the Medicare guideline/standard.) I know this to be true for other insurance issues from working in a hospital for 12 years prior to becoming ill. So even though at the moment I have Blue Shield and should have Medicare in the next few months, it is actually irrelevant b/c the rules are the same.

    They will authorize walkers or regular wheelchairs in which someone pushes you. The reason I cannot walk more than a few steps is b/c of my lung functioning, and not b/c of my legs, so a walker is useless for me. I already have a wheelchair that someone pushes me in which we bought on Amazon in 2014 for $100.

    I wanted the motorized chair for within my apt so I can get to the bathroom, dining table, kitchen, couch, printer, my daughter's room, etc, without someone having to push me or without me trying to make it on my own and ending up sitting on the floor half way there gasping for breath with chest pain. My QOL would be drastically improved with a motorized chair and I could even go down to the lobby to get the mail by myself (which I have not been able to do in close to two years.)

    But according to my cardiologist's office, and now confirmed by the medical supply store, insurance will not cover this for me b/c I am able to stand up and walk a few steps on my own. And the motorized chairs are super expensive around $2-3K. The store we went to only had two models and one was for a much taller person and did not work for me. And the model that did work (which I really liked) is discontinued and not for sale (unless they break the rules and sell me the used model which would be much cheaper but they need the manager's permission on Mon.) So it was a wasted trip but there are other stores that we can try. I am very hesitant to order on-line b/c I need it to fit my height and if it doesn't work, you can't return it. So I need to try it out or rent it first.

    :star: My question is: Has anyone in the U.S. who is not 100% bedbound/paralyzed ever gotten any insurance company (Medicare or private) to cover a portion of a motorized wheelchair? Or is this strictly an item that you purchase privately on your own? :star:

    This rule is pure nonsense IMO b/c there are people who require wheelchairs b/c of cardiac, pulmonary, autonomic or other reasons who still have working legs. It feels like discrimination and pure greed by the insurance industry but what else is new?
     
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  2. SickOfSickness

    SickOfSickness Senior Member

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    That's terrible the rules are so strict about insurance coverage. I think that Medicaid is less strict, but that probably varies from state to state, and I may be wrong. (Also, it sounds like you do not have Medicaid.)

    If you get a used one through a store, it will still cost a lot. I think they sell for around half the price of new. However, if you get a used one from a private party, you can get them for much less.

    I recommend doing this. They go for around 20% to 35% of the price of new for working, good condition and if you shop around they may be cheaper. (But be warned, it is like buying a used car. Some sellers will say the chair is in good condition, and it won't be the bargain it seems to be.)

    There are all kinds of used models, and the private party will understand your need to test drive it.
     
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  3. Gingergrrl

    Gingergrrl Senior Member

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    I can't imagine that Medicaid (which is called Medi-Cal in my state) would ever pay for a motorized wheelchair. I also do not qualify for Medi-Cal.

    The one in the store today, even though it was the store model and people have rented it for years, was still in pretty good shape. It would have been around $1600 to buy (versus 2-3K) but they still rent it out and didn't think the manager would let me buy it so I have to wait until Mon to find out. It fit my height perfectly but the model has been discontinued and is no longer made (which is my luck with everything.) I could rent it for $300 a month and then if I buy it, the rental fee would go to the purchase and it sounded great until they realized they needed the managers permission. It's called a Z-chair. I would love to get one from a private party but no clue how to go about doing this.

    How does someone go about finding a private party who is selling a motorized wheelchair?
     
  4. Gingergrrl

    Gingergrrl Senior Member

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    http://www.scootaround.com/images/pdf/manuals/pridemobility/Pride Z-Chair Owner's Manual.pdf

    This is the chair in case anyone has heard of it or knows how to find one (new or used.) This is all new to me so maybe there is a way and I am missing it.

    ETA: The men who worked at the medical supply store tried the ph# and website that they had but couldn't reach anyone on the weekend to get any info and are supposed to call me on Mon. They seem to only make a newer model now which is for someone about two inches taller than me, even at the lowest height setting. I need one where my back touches the back of chair and my feet touch the foot rests at the same time which so far is only the Z-Chair which is no longer being made.
     
    Last edited: Mar 26, 2016
  5. Jennifer J

    Jennifer J Senior Member

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    Hi, @Gingergrrl. My PCP who retired a couple of years ago, she said she could get me a wheelchair. I'm MediCare/MediCal. She said she fought to get one for another patient with CFS and was able to do so. I couldn't take her up on it because I only have a little room I live in. I don't have any space to put it or move about in it. (It's like the inside of a tight spaced little boat in here.) It would have been great if I could have managed all that's involved in using it, so I could have it for the times I make it out. I wish she was still around so I could find out more for you.

    If this helps at all, at one point in time, I did talk to a wheelchair place in town. They said to get one through insurance, I'd need to need it to move around my living space.


    I agree. It's so messed up....


    I hope your able to get one soon and get it paid through your insurance.
     
  6. Gingergrrl

    Gingergrrl Senior Member

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    Did she say she could get you a regular wheelchair or a motorized wheelchair? I know we are in the same state so insurance rules would be the same. My cardio's office said they have never once had success in getting a motorized chair for a single patient under any insurance plan. Am very interested if your former PCP had a way to do this!!!
     
  7. Sushi

    Sushi Senior Member Albuquerque

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  8. Gingergrrl

    Gingergrrl Senior Member

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    @Sushi, you are a freaking genius and I have never used EBAY in my life (only Amazon) and would never have thought of it. I looked at your link and typed in the chair I wanted and someone is selling one for $500. They only had it for eight months. We sent the seller a msg to ask some questions (like why is she selling it, how much use does it have, can we see it and try it out first, etc.) This may not work but would be awesome if it did.
     
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  9. Kati

    Kati Patient in training

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    Do keep in mind, @Gingergrrl that batteries for power chair/scooters need to be replaced about once a year, and they are not cheap (for me it's 450$). But getting mobility is a very sweet thing.

    Good luck.
     
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  10. Gingergrrl

    Gingergrrl Senior Member

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    Thanks @Kati and I know the battery would have to be replaced (I was not sure of the frequency) and am okay with that. I truly just want to be able to move within my apt from room to room without having to be pushed in manual wheelchair. The thought of being able to go from the bed to the bathroom, kitchen, table, couch, my daughter's room etc, on my own would be like a miracle. I don't even need to take it outside, I just want mobility inside the apt. We do not have a large apt but I am no longer able to walk around on my own due to my breathing being so poor. The cost of the chair and battery is worth it if I can get the one that is right for my height.
     
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  11. Sushi

    Sushi Senior Member Albuquerque

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    You can look up the sellers on Ebay and see how they are rated. Buying from a seller that has good ratings and using PayPal, makes it pretty safe. I have never had a problem with anything I bought on Ebay. Many sellers are sort of like specialty stores that buy up their specialty items from individuals and resell them. Some individuals sell their own stuff on Ebay but the "store" concept is more common. Often you can get totally new items on Ebay as well.
     
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  12. Gingergrrl

    Gingergrrl Senior Member

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    Thanks Sushi and it appears this seller is brand new and is selling her own chair (or maybe a family member's?) vs. being a specialty store or selling a lot of items. She does not have a rating or past history but I am okay with that and will see how she responds to our questions.
     
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  13. Jennifer J

    Jennifer J Senior Member

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    Hi, @Gingergrrl. I'm almost positive it was a motorized one, cause I told her I wouldn't be able to wheel myself in a manual one. If I ever can get to getting together my notes and records from back then, I'll let you know for sure what it is.

    Edit: @Gingergrrl, after thought, I don't know if it was covered under MediCare, it seems like the way coverage works with Medi/Medi, it would be MediCal. I wish I pressed her more at the time to have the knowledge for the future. I had no idea that she was going to all of a sudden retire without even letting any of her patients know.
     
    Last edited: Mar 26, 2016
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  14. Kati

    Kati Patient in training

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    Look up craigslist also, you never know. The bonus is there is no shipping fees (if you find something local that is)
     
    Last edited: Mar 26, 2016
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  15. Gingergrrl

    Gingergrrl Senior Member

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    No worries and please don't spend the energy searching through your notes for me. I was supposed to qualify for Medicare as of this month (March) but never received the packet. My atty who helped me get SSDI said to call 800-Medicare to find out why but have not had a chance to do this yet and I have Blue Shield through Covered CA so am okay at present.

    My former PCP abruptly left her practice in 2012 as well and I adored her and would still be with her to this day. She went to an executive practice that none of her former patients like me were qualified to join. It was such a bummer.
     
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  16. SickOfSickness

    SickOfSickness Senior Member

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    Craigslist is a great source. Another place to buy is Facebook.

    I read the same regarding Medicare coverage of motorized wheelchairs. The doctor has to say that the patient needs it to get around his or her house. Whether the patient can walk a short distance doesn't matter.

    However, I went through a private party for my motorized wheelchair instead of getting one through insurance. Through insurance, you have to have someone come and inspect to make sure the wheelchair would be able to go through the doors, and get measured for one. Also, insurance will only pay for a basic one, so there is almost no choice in what you get. If you go through a private party, you have more options.
     
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  17. Gingergrrl

    Gingergrrl Senior Member

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    SOS, Stupid question b/c I am not a member of FB, but how would someone go about finding a used motorized wheelchair on FB?

    I absolutely 100% need it to get around my apt so if that is the Medicare rule, than the guy at the medical supply store got it wrong. He sounded very sure of himself but that could mean nothing. I know Medicare sets the standard for the other insurances to follow but I did not know what the standard was in this case.

    I am hoping to buy the wheelchair on eBay and waiting to hear back from the seller b/c it is $500 for the exact model that I want and brand new is probably at least 2K. If Medicare or Blue Shield only get you get a basic one and it could not be adjusted low enough for my height, it would be useless. I would actually rather pay more to be guaranteed that I can use it. I've had too many experiences with things where I adjust it to the lowest height and it still is too tall for me.
     
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  18. SickOfSickness

    SickOfSickness Senior Member

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    I hope you get it :)

    You would join local buying and selling Facebook groups. It is similar to buying or selling anything other item. You can search for your city, county, or state name and look for the classified ad groups.
     
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  19. Valentijn

    Valentijn WE ARE KINA

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    I think @SickOfSickness is right about this, solely based on an Elder Law class I took 10 years ago ... so I might be remembering incorrectly. But I think the major distinction was relying on it for getting around the home, versus just needing one for outings and such.

    This .pdf seems to confirm it: https://www.medicare.gov/Pubs/pdf/11046.pdf
     
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  20. Gingergrrl

    Gingergrrl Senior Member

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    You could be right and the guy at the store just didn't know what he was talking about. Will investigate this more some day.
     

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