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

[NW-Will]

The ball is starting to roll to get a new chair through medicare.
This will be my first chair with medicare.

I have an RX for an "Evaluation for New Ultralight Manual Wheelchair"

Which chairs and options are likely to be available to me?
What things should I watch out for, any tips tricks?

To those that have gone through this process what 2 cents would you pass on?

Thanks.

[Lynne]

All I can say about this process is, for me, I worked with "local type" DME's for YEARS trying to get an ultralite chair with NO results. I ended up getting a referral from my Doc to Shepherd Center's seating clinic and things took off. I'm on medicare and ended up in a TiLite ZRA. I can't stress enough the benefit of going to a seating clinic in a top rated (if not Model) SCI center. Nobody ever thought I'd get a titanium chair on medicare. It can happen. You just need to get in front of the folks who know how this stuff is done. Hope it works out for you. I'm so grateful for my ultra lite. It's changed my life!

[CurvySAT05]

I am in the process of getting my first chair funded through Medicare and Medi-Cal (California Medicaid). The first thing you need to do is get a Rx from your doctor for evaluation at a wheelchair seating clinic for a new ultra lightweight wheelchair. You MUST be seen by a OT or PT who specializes in specing wheelchairs (hopefully as good as our very own SCI_OTR). I went to Casa Colina Centers for Rehabilitation (my local rehab hospital) on Thursday to be measured for my new chair. When I went, I met with a PT, a DME supplier that Casa Colina works with a lot, and a representative from Colours Wheelchairs who was able to come with the order forms, chair colors, etc to help out. I am lucky to live very close to Colours. The three "specialists" (I say that b/c they all work with wheelchairs, but have different knowledge bases) all had their own ideas, but we all agreed on what needed to be done really easily, and ultimately they were very respectful of what I wanted and worked around that.
Having gotten my AeroZ a bit over 2 years ago through private insurance, I am almost sure medicare is going to have a fit paying for a new chair so soon. The reason I have to get a new chair is because I just suffered a stress fracture in my left hand from pushing the chair (repetitive use) and need a chair that is a LOT lighter (the way my current chair is set up it is over 30 lbs). My doc wants me close to 15-17 pounds, but I will probably be up around 20-22. We put in for a Colours Zephyr (medicare coded K0009) with a 10" ADI Carbon Fiber back, quick release push handles, Stimulite Classic XS cushion, rigid side guards, Spinergy LX 25" wheels, and D's Locks brakes (I had scissor locks on my Z, but am switching to D's to save the strain on my hands and wrists). My chair will also come with anti tips and a seat belt, but I will take those off the minute I get home!
Getting a K0009 (aka K9) chair approved through Medicare is difficult. They usually only pay for K0005 (K5) chairs. I am hoping that we have enough medical justification to get the K9 paid for with little hassle. In case Medicare and Medi-Cal absolutely REFUSE to pay for the K9 (or down code it to K5) we have also filled out the order form for the Colours Razorblade which is a K5 and should be approved easier. The Razorblade is heavier, and has more adjustability and moving parts (aka things for me to break) than the Zephyr, so I really need the Zephyr to go through.
Once Medicare approves the new chair (approval could take 3 months), the DME supplier will submit the order to Colours to have my new chair built to spec.
The main thing you need to do now is find a seating therapist in your area who can evaluate you and write your letter of medical necessity (LMN). The LMN is what Medicare uses to approve or deny your chair, so make sure that the therapist has all the information you could ever give for that letter. The more documentation the better your chances of getting the chair that you want and need.
Good luck. It sounds like we will be getting our new chairs around the same time.
Mandy

[NW-Will]

Rx has made it to the seating specialist and have an appointment with the seating specialist and DME next week.

Me : 6' 230lbs T4 - Been pushing a Quickie Gt + 26" wheels + Natural fits.

The seating specialist recommends I look at ...
Kimobility
Colours
Tilite
Incacare topend

The DME recommends I look at ...
Topend Invacare T7 / T7A
Quickie Q7
Ti-lite Aero ZR / ZRA ; Aero Rigid
Kimobility Tsunami

Hoping to get a fixed back and thinking box frame.
Downside to my quickie... the fastener hex heads can't take the constant tightening, and some of the fastener receivers have lost their thread.

Found out, as I have Medicare/medicaid you can't pay to upgrade your ride. Apparently if you only have Medicare, you can pay the difference to upgrade your chair.

Has anyone managed to get Natural fit push rims on Medicare/medicaid ?

With my camber, my total width comes in at just over 29" at the moment, it seems as though the sweet spot for getting through the majority of doors is a hair less than 29". So I'm interested in a chair where you can swap out the camber tubes, for those moments when I really want to make myself narrow, just a thought at this point.

Has anyone got a suspension chair on Medicare/Medicaid ?

Thanks for the comments guys.

[ancientgimp]

I broke the only fixed back chair I had and since have used folding backs which seem stronger to me. I don't need folding back as I use van and don't normally stow chair but if you ever travel with friends and need to get your chair in trunk of a subcompact, you will miss a folding back.

[BobMach]

I am due for a Medicare chair in Nov so this time i am going to bypass local DME's and look into Jefferson Hospital in Philadelphia with a great letter from my Doc to give the TiLite ZR/ZRA request a try. I am also close to both Moss & McGee Rehab's, wonder if they would be a better choices.

[cheesecake]

I am due for a Medicare chair in Nov so this time i am going to bypass local DME's and look into Jefferson Hospital in Philadelphia with a great letter from my Doc to give the TiLite ZR/ZRA request a try. I am also close to both Moss & McGee Rehab's, wonder if they would be a better choices.

McGee has an excellent seating clinic. Start planning now as good seating evals take awhile to get.

You will still have to go through a DME unless you want to pay cash and order online.

[SCIfor55+yrs.]

I am jumping through the Medicare hoops now getting a power chair and it takes time. Given the Medicare protocol, you are going to have to use a DME. The DME is supposed to fill the prescription you get from the seating eval. Regarding add-ons like a suspension system, it has to have an assigned Medicare code or you can forget it. If it does, the Rx will have to explain why it is medically necessary and provide supporting evidence.

[Lynne]

As has been said here, yes, you DO have to go through a DME, but, as I found, the seating clinics at the larger SCI centers have DME's they regularly work with. The DME was present at the eval the seating specialist did, even commenting he didn't think Medicare would approve a titanium chair. Well, after the seating specialist got finished writing all of his stuff ( that took a while, because he emailed me several times about my wants/needs as well!). It wasn't a problem. All my Doc had done was make the appt. for me with a script for an eval for an ultralight chair with appropriate skin sparing cushion to prevent pressure sores. The seating specialist was great, getting it approved.

[cheesecake]

I am jumping through the Medicare hoops now getting a power chair and it takes time. Given the Medicare protocol, you are going to have to use a DME. The DME is supposed to fill the prescription you get from the seating eval. Regarding add-ons like a suspension system, it has to have an assigned Medicare code or you can forget it. If it does, the Rx will have to explain why it is medically necessary and provide supporting evidence.

SCI 55: You live in one of the Medicare single payor regions. Please keep me posted on your progress. There have been a number of issues with this new process and efforts are being made to prevent SCI's who need chairs from getting snagged in the process.

[SCIfor55+yrs.]

SCI 55: You live in one of the Medicare single payor regions. Please keep me posted on your progress. There have been a number of issues with this new process and efforts are being made to prevent SCI's who need chairs from getting snagged in the process.

I will certainly keep posting things as they unfold. The procedure has already taken a toll. My need for a power chair is really an emergency because my power assist died and is not fixable or replaceable. I have not been able to find a useable power chair substitute so I am struggling with a manual chair. It has taken a terrible toll on my damaged shoulders. We had managed to get the pain under control about 2 years ago, but I have regressed to the point I was at before. I have been struggling for about 2 months already and may have another 6 weeks or so ahead. We are waiting for the ADMN to be returned from Medicare. I have already been warned about the likely need to appeal the request for an elevating seat lift despite the medical justification that has been provided.

[betheny]

can you rent one from a home health care place, or buy one used at a pawn shop? Our local sci rehab has a pawn shop right across the street, there are always dozens of power chairs out front. If you buy one that way you eventually should be able to recoup most of your investment imo. Would def cost less than new shoulders! Best case scenario, you keep the 2nd hand one around for back up.

We all need back up chairs. honestly.

[SCIfor55+yrs.]

Thanks bethany. However, SC is a very poor state and wheelchairs and other equipment do not sit around. There is an organization here that does that and they have a waiting list. I found a used possible rental at a DME but it was a huge one that would not work in my house. Because I am in the transition stage, I do not have a backup power chair. My backup is a manual, but as I said, it is killing. Not remaining active would prettyl much do the same thing at my age.

[cheesecake]

I will certainly keep posting things as they unfold. The procedure has already taken a toll. My need for a power chair is really an emergency because my power assist died and is not fixable or replaceable. I have not been able to find a useable power chair substitute so I am struggling with a manual chair. It has taken a terrible toll on my damaged shoulders. We had managed to get the pain under control about 2 years ago, but I have regressed to the point I was at before. I have been struggling for about 2 months already and may have another 6 weeks or so ahead. We are waiting for the ADMN to be returned from Medicare. I have already been warned about the likely need to appeal the request for an elevating seat lift despite the medical justification that has been provided.

There is a phone number that is accepting complaints from individuals who are having trouble because of the new single payor system that has been implemented in some states.

NW-Will, if you are in Seattle you are in the next region for implementation so get your equipment ASAP.

[SCIfor55+yrs.]

There is a phone number that is accepting complaints from individuals who are having trouble because of the new single payor system that has been implemented in some states.

NW-Will, if you are in Seattle you are in the next region for implementation so get your equipment ASAP.

Can you point me to that phone number? Thanks.