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.
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?
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?
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.
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? 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?
