Medicare covers a new chair every five years. What they don’t cover is how the process works. Below, I’ll share some lessons we learned on our very frustrating journey.
Earlier this year, my husband Arthur was eligible for a new wheelchair that Medicare would cover. He opted not to order one. Fast-forward nine months. I received a frantic call that his wheelchair broke; the wheel assembly to the frame collapsed. Yikes! His wheels are his legs! What do you do when your custom wheelchair is non functional?
I quickly reached out to neighbors (we live in an over 55 community) and they guided me to a service the community provides where people donate used medical equipment they no longer need. I raced over to the shed and found a serviceable wheelchair – the kind you would take your grandmother out to dinner in. Look for services like these in your county or development should you need them.
Next, we began the process of ordering both a new wheelchair and an appointment to repair his current wheelchair. Your process may be different if you have just had your injury and it’s your first wheelchair. Arthur has been a para since 2015, he’s living independently and is on his second wheelchair.
I’ll skip all the back and forth it took to get the scripts for both and the mistakes the doctor made and get right to the first lesson that we learned:
Find out if you need a Wheelchair Face-to-Face Evaluation.When ordering a new wheelchair, Medicare (and other insurance companies) require a face-to-face with the doctor and specific information. Without this information, they may turn the request down. Unfortunately, we didn’t learn this until we went to his wheelchair evaluation. Now we have to go back to the doctor and get the face-to-face.
Ask if the rehab or place you are getting fitted has wheelchairs to try out. We set up an appointment with National Rehab Hospital in DC to have Arthur measured for his new wheelchair. But how does he get to choose his new chair? Where does he try them out?
Fortunately, NRH has a room full of wheelchairs as well as backrests and seat pads. If you’re getting the same model and the rep is coming to your home, trying a new wheelchair may not matter. But Arthur changed companies and needed to know what wheelchairs were available.
Do some research about wheelchair manufacturers so you know your options. Check out Spinal Cord Injury and Wheelchair groups on Facebook. They were very helpful when I asked what chairs they liked.
When you schedule your appointment, ask how much time you will have with the therapist. At Arthur’s appointment to get measured for his new wheelchair, the Occupational Therapist took a lot of information from Arthur. Arthur was giving thorough, if lengthy, answers. When we moved to the room to try out wheelchairs, we were told we had only twenty-five minutes left to our allotted time slot.
Had we known at the beginning that our appointment was an hour and a half, we would have talked less and spent more time choosing the wheelchair. As it was, we hastened through the process to avoid the necessity of making another appointment. A caveat here: our therapist was wonderful and did not rush us, but we did not want to have to reschedule and wait another few weeks for his chair.
Medicare or your insurance company determines what it will cover. Titanium is out. Aluminum is in. Those cute red accents on the front? Upgrades. Those lime green spokes on the wheels? Upgrades.
While choosing a wheelchair, we learned that only the frame is standard. Everything else is custom. Arthur could choose the color of his chair, the type of back support he wanted and the seat cushion. He also had some choice of details, like which footbed he wanted (based on what the company offered) and how wide he wants his wheels set. He could choose from two types of brakes, whether he wanted armrests and which type he wanted. Some choices are not reversible – like the type of footbed, although it is adjustable. Be aware of the choices and the options that are not reversible.
And don’t expect a Rolls Royce unless you want to invest in all the bell and whistles.
Medicare may not want to cover both a repair and a new wheelchair. While we were at our appointment, we told the therapist that Arthur had ordered repairs on his current wheelchair, which he hoped to have until the new one was in and also to use as a backup. We learned that If two tickets are in for the same time period, there’s a good chance they won’t want to cover both. They may choose the less expensive option. We opted to cancel the order to repair his wheelchair. It was too big a risk.
Don’t wait to order your new wheelchair. Find out if you can get evaluated before your five years are up. Be ready to order it as soon as you can. Had my husband ordered his earlier, he wouldn’t be in this painfully uncomfortable wheelchair while working through this frustrating process.
We also learned that there are wheelchair manufacturers and companies that represent the manufacturers.
Lastly, don’t be in a hurry. Your wheelchair will be custom buillt so be ready to wait several months for your new ride!
I hope this helps you through a painful and lengthy process. Please let us know what lessons you learned and if these helped you!
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Angela DiCicco, The Italian Grandmama
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