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I need to get a replacement power chair for my spouse. We originally got the current one in late 2004 after a ridiculous amount of going back and forth, getting a doctor to write the order, etc.
We finally got one in December of 2005. The insurance carrier who originally agreed to pay recinded their agreement with the scooter company, who's been after me ever since to pay it. In that time, she's need two major repairs, one for the seat cushions, and one for the controller. The scooter company has refused to cover any of the repairs, so I've been working with a local company who's been able to order the parts and do them instead. She starting having problems with the new controller back at the beginning of the year, so once again I called the local store, and they told me they'd order another controller. As of yesterday, my wife calls me and tells me that still no one's come out to fix her chair. I called the store, and they told me they were still waiting for the part. I have a feeling it's never going to come until the original chair order is paid for.
Now, I don't know why the Assisted Living Center, her doctor, or her neurologist can't deal with this, but apparently it's once again up to me to somehow make this all happen.
What do I have to do to get her a new chair? This one is obviously shot. She absolutely has to have one to get around and can't keep having these mechanical and electrical problems. Are there leasing options available? Is there an authority I can go to?
What type of insurance does she have? I must say that while I completely sympathise with the frustrations of trying to set up DMEs I can also understand any reluctance on the behalf of the powerchair company to provide any services or repairs on a chair that is apparently STILL unpaid from 2005. The agreement that either your wife (or you as her representative) must have signed usually has it stated that ultimately it is up to the individual to PAY for the provided equipment regardless of any insurance issues.
If you are looking for a brand new chair then you must start the entire process over again from the Dr. appointment, prescription, insurance agreements and perhaps a seating clinic. I would not be surprised to find that your wife's name has made some sort of list that many providers circulate that marks her as a non-payer.
If your wife has Medicare part B then she may be eligible for a new chair (the earliest is five years) in December. They pay 80% of the cost of the chair.
I DO wish you good luck, it can be a frustrating process (I have been in powerchairs since 1995) but if your wife truly is need of a powerchair then you can only go through the process and have all of your paperwork and insurance issues covered.
Oh, and although it is certainly NICE for ILC and Doctors to assist with the paperwork portion of acquiring a new chair it certainly does NOT release either you or your wife of the basic responsibility of ensuring that everything needed is provided. If your wife has a caseworker he/she often are able to facilitate the process.
Well, the scooter company states in their commercials that, if they pre-qualify you for a chair at no cost to you, and if your insurance doesn't cover the cost, then you get it for free. Obviously they're not standing behind their claim.
Anyway, if you look at statistics for life expectancy, she will be deceased WAY before she can ever qualify for Medicare Part B.
Well, the scooter company states in their commercials that, if they pre-qualify you for a chair at no cost to you, and if your insurance doesn't cover the cost, then you get it for free. Obviously they're not standing behind their claim.
Anyway, if you look at statistics for life expectancy, she will be deceased WAY before she can ever qualify for Medicare Part B.
Well, you are obviously not planning on paying for the first chair, but I certainly would not expect them to do business with your family a second time (I would be very surprised if they were to continue to service a 'free' chair), so do you have a DME provider in mind that will work with your insurance?.
I am WELL under 65 (in my early forties) and have Medicare Part A&B because I am disabled. Is your wife not considered to be disabled (SSI/SSDI)? My chairs are completely paid for with no problems (but then I have always used reputable DME providers).
In any case, you need to start the paperwork over again in order to qualify for a new chair. I certainly would not count on any agencies to take care of the work (although many are willing to help). This is why I asked if your wife had a caseworker- he/she knows the ins and outs of the paperwork and what providers work well with your Insurance(s).
I am only trying to help you. I have had three brand new powerchairs at five-six year increments and have never had a problem with paperwork, DME providers or my Medicare & private insurance.
It is all in how YOU advocate for your wife (if she is unable to do so for herself). Has she even had a proper seating clinic or are you just buying a generic chair and hoping that it is the proper chair for her needs?
What does your insurance cover? That is usually the first place to start! If you have any specific questions I more than happy to answer your questions.
You need to do the work yourself. The doc only writes the Rx the rest is up the the individual to follow through.
Be an advocate for your wife and deal with it.
They are denying many people for chairs if they can wheel themselves even a little. It's rough and only will get worse with the new medicare guidelines coming down the pike compliments of the government. Now all insurance company's must follow medicare guidelines (you almost need a secondary insurance).
It took me 9 months to finally get an order approved for my chair only for me to cancel it because it was no longer suited to my needs. Now I bought a $250 standard wheelchair and deal with it. I would love a scooter but since I have upper body mobility I cannot be approved for it and since I already had a wheelchair assessment and fitting for a chair I have to pay out of pocket for the next one so tell me about frustration.
You must go through the steps to get it; no one else is going to do it.
And dealing with a reputable DME place is very good advice.
is there any exception the 5 year rule. My mother got a chair 3 year ago, however, now she is larger and unable to stand easly. I would like to get the larger chair and perhaps it has the stand up capability. So does anyone have any knowledge of if there is an exception on the 5 year rule.
Usually the only time that Medicare will authorize a new chair is if the old chair is completely unusable (more than 90% in need of repair).
The best place to start is by calling Social Security and asking when she is eligible for a new chair; unfortunately, weight gain is usually not considered to be a good reason for a new chair, but it never hurts to ask.
As far as a powerchair with standing capability it is very difficult for that type of chair to be authorized without very specific diagnoses (difficulty standing is not one).
I cannot stand at all and my new chair is pretty spectacular but no go for the standing option. My new chair was close to $45,000; but I have conditions that warrant such a chair.
Does your Mother have a caseworker? If not, the best place to start is with her Doctor, (physical therapist- if she sees one) and with Social Security. I wish you luck and I hope that your Mother is able to get a chair that makes her more comfortable.
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