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$10,000.00+ For a Tilite ZR

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    #16
    Originally posted by stephen212 View Post
    So then the in-network DMEs are jacking up the quotes knowing that the insurance companies will only pay the contracted rate while sticking the subscribers with inflated co-insurance charges. Otherwise what's the point of the inflated quotes? Or do they write off the difference hoping for a tax break? Whatever the explanation, the system as is is fucked.
    i only know what happened in my case. i assume it's somewhat similar elsewhere. but yeah, i agree with the rest of your conclusion.

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      #17
      Originally posted by stephen212 View Post
      So then the in-network DMEs are jacking up the quotes knowing that the insurance companies will only pay the contracted rate while sticking the subscribers with inflated co-insurance charges. Otherwise what's the point of the inflated quotes? Or do they write off the difference hoping for a tax break? Whatever the explanation, the system as is is fucked.
      With the DME stuff there is not typically a contracted rate between the DME provider and the ins. co., rather their reimbursement is governed by the annual limit for DME, according to the benefit plan the member is paying for. I've never seen a provider contract (and I've seen a few...thousand) which prescribed a flat rate in exchange for a variable cost piece of equipment like a wheelchair. Being 'In-network' for DME shops has more to do with their credentialing and/or certification than their reimbursement, in my experience.

      Brianm has to appeal just to get an upgrade from K0001 and Titanium4Motion has 100% covered on a $10k, K0009 chair. It's all about your contract between the ins. co. and you, aka your "benefit plan", not your needs (unless as defined within the BP ).

      The ins. co.'s position is that you should have thought about your potential needs when you entered into the contract with them to cover some portion of your potential future medical cost. Many ppl just look for the cheapest option on the 'compare plans' form they get from HR and then wonder why they're ins. co. is so cheap with them. Duh. Nobody wants to pay for it but everyone wants the best care, regardless of their premiums, when it comes down to it. And for those who would pay for added protection many don't believe the have any choice because they're beholden to whatever quality plans their employer want to share cost on. Not true, but it seems most folks are pretty ambivalent about it, and take whatever their fed.

      But, in the end it's about means and medians and basic risk management. The actuaries work near tirelessly at ins. co.'s and are far from stupid. Their job is to make sure that for every Titanium4Motion that comes by with a $10k chair there are thousands of others paying fat premiums to make it well worth their while to be in business. Insurance is a racket.

      The only for certain influence we can have on all this is to stay healthy. We wouldn't be having a "health care" crisis in this country if we didn't have a corresponding crisis of "health", in general. Back away from the buffet, America! End this ridiculous addiction to fat, sugar and salt! Take your fate back from the hands of for profit medical and insurance markets!

      Oh...sorry...my 'get your shit together, America!" tourettes fired off there...I know we are a captive audience and can't much control our need of a chair, but we can understand our contracts when we sign them so we won't be upset when we don't end up getting what we think we deserve out of an insurance company!
      "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

      "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

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        #18
        Can't believe the companies in the states charge above MSRP, Don't think I've ever paid MSRP always less.

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          #19
          Originally posted by fuentejps View Post
          on mine, they are making prob 4500
          John, F this. I would rather have a caring, knowledgeable PT measure me out, print out spec sheets from manufacturer's web site and then submit to Spinlife/Sportaide(ugh) for the chair. Shit, I'd rather just slip someone a couple hundred dollars tax-free, direct rather than this.
          And the truth shall set you free.

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            #20
            Originally posted by Notwoodward View Post
            i only know what happened in my case. i assume it's somewhat similar elsewhere. but yeah, i agree with the rest of your conclusion.
            they make monies on the misc codes and whatever they have contracted and agreed on w/ tilite. then our copay is bsed on the inflated price. still im only paying 1k, which isnt much, but to some it may be. my gripe is, i do EVERYTHING, they just bill, i never even see them.
            Bike-on.com rep
            John@bike-on.com
            c4/5 inc funtioning c6. 28 yrs post.
            sponsored handcycle racer

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              #21
              Originally posted by NoDecafPlz View Post
              John, F this. I would rather have a caring, knowledgeable PT measure me out, print out spec sheets from manufacturer's web site and then submit to Spinlife/Sportaide(ugh) for the chair. Shit, I'd rather just slip someone a couple hundred dollars tax-free, direct rather than this.
              i wouldnt let a pt spec me out for anything. i do it all myself
              Bike-on.com rep
              John@bike-on.com
              c4/5 inc funtioning c6. 28 yrs post.
              sponsored handcycle racer

              Comment


                #22
                I talked with a guy yesterday and asked him if they charge MSRP and he said they bill MSRP but insurance companies usually pay part (most) of this and the client is left with the rest and they simply accept what the insurance company pays. Clearly not all follow this policy.
                C5-6 Complete - 8/13/1982

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                  #23
                  Originally posted by fuentejps View Post
                  i wouldnt let a pt spec me out for anything. i do it all myself
                  John, why are you paying someone a commission when you don't even need them to spec you out? Every DME rep I've ever dealt with is a used car salesman. Even if you have a good rep there, why pay an extra couple hundred, thousand, whatever?
                  And the truth shall set you free.

                  Comment


                    #24
                    Spec. sheets

                    Originally posted by fuentejps View Post
                    I wouldn't let a pt spec me out for anything. i do it all myself.
                    I agree with you on this.

                    I did my own specification sheet that Tilite provided at their web site. It was required by my insurance company that I get fitted by a physical therapist. I also had additional modifications that I wrote on a separate sheet of paper. My first Tilite 'chair I got fitted from the therapists at the Cleveland Clinic. There is where I learned about Otto Boch "The Cloud" cushion. These men and women knew their stuff!

                    "Fresh outs" don't even have a clue about a 'chair. It is after so many years later that they know what they want on a 'chair.

                    My first 'chair was an eighteen inch width. It was huge! I asked the salesperson during the fitting of my second 'chair, "Why was I fitted for an 18" width frame?" He replied back, "In many cases the patient gains weight over the years that is why I was fitted with an 18" not a 16" inch frame."[1] It was a big difference going from 18" to 16" frame width. That is why I always watch what I eat and keep my weight down.

                    I'll have some pictures this weekend of my Tilite ZR.


                    titanium4motion
                    [1] Miller's Omed, Cleveland, Ohio
                    "We must overcome difficulties rather than being overcome by difficulties."

                    Comment


                      #25
                      Equipment questions

                      I'm new to this forum. I was injured in 1980, C6-7. I'm 51 and in the best shape of my life. I just had twin boys on the 4th of July and I have a 17yr old son and 3 yr old girl. I've lost about 40 lbs over the last 6 years by cardio, diet and weights. I'm 5'8 and went from a size 36 to 30, 175 lbs to 135.
                      I've been driving a 7 series BMW, with a Robot 2001 that comes from the trunk and takes my TILITE folding chair. (kinomobity.com if you want to check out robot)
                      I recently had a problem w/robot and now I have to drive from Boston to Toronto for service. It's been great for 5 years and I think the computer got screwed up because I got stuck in a downpour w/the robot fully extended.
                      I've been reading your post and I'm wondering if it's time for a rigid chair and if there is someone in the Boston area that could advise me on adjustments, size, etc. Also, I'd like to stick with a bigger, higher-end car, BMW, Benz, Audi, or another suggestion. I would give up the robot, but need something easy to get chair in.

                      Thanks

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                        #26
                        Originally posted by titanium4motion View Post

                        I'll have some pictures this weekend of my Tilite ZR.
                        Guess your camera broke
                        stephen@bike-on.com

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                          #27
                          Do you need glasses?

                          Originally posted by stephen212 View Post
                          Guess your camera broke
                          Look at my original post. The pictures are there.

                          titanium4motion
                          "We must overcome difficulties rather than being overcome by difficulties."

                          Comment


                            #28
                            Originally posted by titanium4motion View Post
                            Look at my original post. The pictures are there.

                            titanium4motion
                            Indeed!

                            What's the angle of the backrest?
                            stephen@bike-on.com

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                              #29
                              not 'possible to see some photos of your ZR thanks

                              Comment


                                #30
                                I know this happens in all claims not just medical... But no wonder we're paying with our limbs when insurance companies are charged such exorbitant dollars when you yourself could go to sport aid or even the manufacturer themselves and pay half that... insurance companies are so freekin crooked its not funny. the companies that deal with them are accessories after the fact. this is so messed up...

                                I am riled because my own insurance costs are through the roof. and that's not public indemnity either that's another story. It can't be oil that's driving up the cost of living it's the cost of insurance.

                                Damn shameful!!!

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