Does anyone know how often insurance will cover a wheelchair? We have private insurance (Highmark) and Medical Assistance (Gateway). Jack received his first wheelchair in December of 2006 (although it was ordered nearly a year before then -- they go by the date delivered). We recently had it adjusted for growth -- and while he fits well now I am not sure how long until his next growth spurt.
Also, he isn't able to use the chair with both arms functionally. Since I knew NOTHING about wheelchairs before his first one, I trusted the seating clinic to know what to order. The chair simply does not work for independent mobility. We are in need of a one arm drive system (where the user can use two hand rims to maneuver on one side of the wheelchair). This will prevent the large circles he is doing now...which of course frustrates him!
This is becoming even more important as he enters Kindergarten. He will use his walker for short distances -- but he fatigues easily and will need his wheelchair even more this coming school year to get around the large elementary school.
His physiatrist would provide us with all letters of medical necessity as well as the prescription and we would use a local DME instead of the seating clinic this time.
There is only one pediatric wheelchair system that offers a one arm drive and luckily it's a brand that insurance companies have been known to cover (because it's less expensive than others, and pretty much a simple, unfancy chair).
I really wish I would have known then what I know now about wheelchairs. There's nothing worse than being stuck with something that doesn't work...
Any tips, advice, words of wisdom for getting insurance to cover the new chair would be appreciated!
I am considering paying out of pocket if we can't get insurance to cover it. Now, I just need to find $3500!!!!! Let me see if the money tree has grown yet, lol! In all seriousness that isn't very expensive when it comes to a wheelchair. Jack's current chair was nearly $8000. Insane, since it DOESN'T WORK for him.
I know nothing Angela, but say it cant hurt to try. Which insurance paid for the current one. Was it your primary...or did it have to go to medicaid? If it was primary and they deny it this time, medicaid in PA should pick it up without much of a fight.
ReplyDeleteRight now we're fighting for a Convaid (or similar) stroller for J. Huge hugs!
I was told they would pay for a chair every 5 years. However, I think you should definitely fight to get something else. Submit the necessary paperwork and go from there. Just don't be afraid to appeal it when you need to.
ReplyDeleteI've been so worried about ordering the wrong thing that I haven't done anything. We are using a borrowed manual chair and I can see that it isn't going to provide the independence that we had hoped. We are still hoping for a powerchair. I think I asked you about it before (I apologize) but I can totally see Jack buzzing around in one.
Do you have a Shriners there? I know some have used them for equipment.
I don't have anything to tell you since I'm behind you on this journey. Maybe you could sell the wheelchair you don't need an use the money to buy one that works for you. Or is that against the law?
ReplyDeleteUnfortunately selling the chair wouldn't bring much money at all. Maybe a few hundred dollars. When we do get a chair that works for Jack I will most likely donate his current chair to DDS (his current early intervention provider).
ReplyDeleteI plan on getting all of our ducks in a row and trying it through insurance first.
To those who haven't gotten their first wheelchair (or other equipment) please, test as many items as you can first! I wish we would have...
I will keep you posted!
Oh and Mel, yes, we are considering a powerchair, but only in the future. We tested one at the seatinc clinic recently and I am worried about safety. I think he needs a few years before he's ready!
ReplyDeleteThis must be very frustrating! It's good that you know what will work for Jack!!
ReplyDeleteWe are still borrowing one from our seating clinic, but I know Abby will be growing out of it before too long... and then we will be riding in your boat.
I honestly don't know much about wheel chairs except from observation of other special needs kids. It seems to me that insurance should cover it b/c it is Jack's main mode of mobility! I'd say fight it until they pay. Do you have a medical rep who handles all of Jack's other needs through insurance? We were recently assigned one and she has been helpful getting us the info we needed.
-Patty
It's disgraceful how expensive products are for disabled people.
ReplyDeleteOver the last few years I have spent £10,000 (about $20,000) on wheelchairs.
Even with the development costs, there is no reason why products should be so expensive.