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New Chair through Medicare - What are my options, things to watch out for?

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    #46
    Originally posted by dnaL0R View Post
    i see where you are coming from, but this guy is not as bad as i make him sound...

    my case sort of got on hold since he said he could not do anything further since i can propel the chair by myself... instead of throwing the case in the "pending" file, he actually followed through and did some more research[?], since he sent me an email earlier today stating that he is setting up an appointment for me at rancho los amigos... so he must have figured something out, i mean, what he originally told me did not sound right; seemed like a requirement to get a powered chair or something in that nature...

    it is too soon for me to tell, but it is definitely starting to go in the right direction... i will be giving him a call tomorrow to follow up.
    Good luck Man. All I can say is I have been getting the run around for months. Yes I am on medicare and medicaid. we even tried using my wifes insurance. What a night mare. Hey If I were you I'd push for a Icon Or a Q7.
    Q7's tip easy so becareful if you choose that route. TA7 is alot of hard wear that could fall off. but it looks kool. Tilite just wasn't for me. I sat in a Q7 and I fell inlove. althou I am a quickie guy. The Icon Really has a sex appeal. and I really like it but Dam You really have to have a good seating write up about why you need that chair. I would love to have one. concidering I have owned my GPV for 7 years almost 8.

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      #47
      Originally posted by randomryan007 View Post
      Good luck Man. All I can say is I have been getting the run around for months. Yes I am on medicare and medicaid. we even tried using my wifes insurance. What a night mare. Hey If I were you I'd push for a Icon Or a Q7.
      Q7's tip easy so becareful if you choose that route. TA7 is alot of hard wear that could fall off. but it looks kool. Tilite just wasn't for me. I sat in a Q7 and I fell inlove. althou I am a quickie guy. The Icon Really has a sex appeal. and I really like it but Dam You really have to have a good seating write up about why you need that chair. I would love to have one. concidering I have owned my GPV for 7 years almost 8.
      i am sorry to hear about your poor experiences... i hope i can get that write up pretty soon and i will be on my way to rancho, i have heard from another member on here that they have various demo chairs there that i can test out, so i am pretty excited... my battle has just begun...

      :knock on wood:
      sigpic

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        #48
        I started the process back in June 2011, June 15th.
        Had the chair fitted and everything.
        My DME called me today and told me Medicare only pays for a chair after 5 years!
        Even though they never paid for my original chair.
        Been in my original chair coming up for 4 years now.

        Supposed to be getting it because my current chair doesn't fit me properly.

        Just another bump in the road I guess... the joys of SCI.

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          #49
          I too am having trouble obtaining a decent ultra lightweight wheelchair through Medicare. The local medical supplier told me that because of Medicare's rules, I was only able to get a standard lightweight manual wheelchair, because of their "indoor-only" policy. He told me that I would qualify for a standard wheelchair like the Breezy Ultra 4, or E&J Metro IC4, but not a Quickie 2HP or any Quickie rigid frame wheelchair. They told me that if i couldn't move the standard chairs around that are mentioned above, then they'd recommend I use a power chair. I can move the chairs and stuff, but it would be hard to do this everyday, due to the weight of these standard chairs. I don't want a power chair, EVER! This was back in April when they told me all of this.

          Has the rules changed recently? A friend of mine who is on the same type of social security program as me (Adult Child Disability Benefit) got an ultra lightweight chair with the E-Motion power assist and Natural-Fit handrims no problem. He is on both Medicare and Medicaid, like me, but I keep getting the runaround.

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            #50
            Originally posted by NW-Will View Post
            I started the process back in June 2011, June 15th.
            Had the chair fitted and everything.
            My DME called me today and told me Medicare only pays for a chair after 5 years!
            Even though they never paid for my original chair.
            Been in my original chair coming up for 4 years now.

            Supposed to be getting it because my current chair doesn't fit me properly.

            Just another bump in the road I guess... the joys of SCI.
            this will be my first chair thru medicare/medical, so i should be ok... is it possible that they've paid partially? that is how it was for my first/current chair, though, it was thru private insurance...

            i got an update from my case manager and he told me that they've already sent out a referral to rancho for a seating eval... just waiting on a call back and hopefully i can make an appointment soon...
            sigpic

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              #51
              UPDATE:
              received a call from Rancho Los Amigos and made an appointment for next month :woot:
              sigpic

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                #52
                got it :]

                sigpic

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                  #54
                  Nice looking chair, dnaLOR. Glad you finally got it.
                  Please donate a dollar a day at http://justadollarplease.org.
                  Copy and paste this message to the bottom of your signature.

                  Thanks!

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                    #55
                    Woo hoo... received the denial from Medicare. DME is allegedly re-applying!

                    Originally posted by NW-Will View Post
                    ( 06-08-2011, 06:39 PM ) Rx has made it to the seating specialist and have an appointment with the seating specialist and DME next week.

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                      #56
                      thanks rdf... yea, it took a few months, but it's finally here !

                      i hope not too much run-around on your end NW-Will :[
                      sigpic

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                        #57
                        Originally posted by dnaL0R View Post
                        thanks rdf... yea, it took a few months, but it's finally here !

                        i hope not too much run-around on your end NW-Will :[
                        sweet, nothin like a new ride under ur ass to make ur week

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                          #58
                          The denial that the DME received, funny how they don't send me a copy, I get a copy of everything else from Medicare, but the one thing that is kind of interesting I don't get.

                          I wonder how much this is just a standard template they just send out every time?

                          You'd think the DME would be wise to this and know that this info would be required upfront, without having to go backward and forward.

                          They are/were shooting for a TR !



                          Last edited by NW-Will; 5 Apr 2012, 5:44 PM.

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                            #59
                            Whoa, I'm sorry Bro, but if your DME submitted for payment through CMS without ANY of the documentation cited as missing,for a K0009 coded chair, no less, it was BOUND to get shot down. That's a bunch of standard crap that wasn't included, if each bullet point in the document is missing.

                            That's not to say you don't deserve or need the chair...I'm sure you do...and certainly hope you get it...but that's just incompetence on part of the DME, IMO!

                            The OT should have known better, too, doesn't there have to be one involved to get a Medicare chair?

                            Sorry, man, I hope you get it sorted!!

                            Originally posted by NW-Will View Post
                            The denial that the DME received, funny how they don't send me a copy, I get a copy of everything else from Medicare, but the one thing that is kind of interesting I don't get.

                            I wonder how much this is just a standard template they just send out every time?

                            You'd think the DME would be wise to this and know that this info would be required upfront, without having to go backward and forward.

                            They are/were shooting for a TR !



                            "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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                              #60
                              Wow, yea from the letter alone it sounds like the DME didn't do any of the stuff required. Is the DME experienced with medicare? I got lucky in that I found a local DME that had a lot of experience with medicaid and they turned out to be really good, they did tons of paperwork and everything sailed through medicaid approval which shocked me.

                              If I'm understanding that letter right, there is a time limit on how frequently you can request?? If so, make sure everything is right BEFORE its submitted to medicare next time! I'd demand copies of everything they're going to send to medicare before its sent to medicare, make sure nothing is missing yourself if you have to!
                              Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

                              I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

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