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medicaid/medicare paying for wheelchair

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    #16
    I *THINK* what was being said is that your prescription has to specify EVERYTHING that you need in order for Medicare to cover it ie:anti-tip bars, taper, solid seat pan, adjustable back rest, etc...otherwise they'll be considered options & be added on afterwards at full list price and you are responsible for them out-of-pocket...
    'Chelle
    L-1 inc 11/24/03

    "My Give-a-Damn's Busted"......

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      #17
      Originally posted by Broknwing View Post
      I *THINK* what was being said is that your prescription has to specify EVERYTHING that you need in order for Medicare to cover it ie:anti-tip bars, taper, solid seat pan, adjustable back rest, etc...otherwise they'll be considered options & be added on afterwards at full list price and you are responsible for them out-of-pocket...
      i got ya.....

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        #18
        Earlier in the year, my PT was looking into getting me a lighter wheelchair, because the one I have (Quickie GP) is too heavy and I was starting to get what she refered to as "wheelchair shoulder". We talked to a local medical supplier and he told me that Medicare pays 80% and Medicaid pays 20%, if you are on both of them at the same time.

        Unfortunately, because of that stupid "indoor-only" rule, the medical supplier told me that Medicare rarely covers ultra lightweight manual wheelchairs. I had wanted a Quickie GT wheelchair, but the supplier told me that Medicare would refuse to pay for it, claiming that if I couldn't push a standard wheelchair indoors easily, then I needed a power wheelchair. I absolutely DO NOT want a power wheelchair. I wish the Medicare DME rules were different. Not all disabled adults want to spend their time indoors, and the standard wheelchairs are way too hard to push around for long distances indoors and outdoors, especially on uneven terrain.

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          #19
          Does anyone have anymore tips or ideas on this topic? I'm about to start the process and really want a nice tilte ZR series 2. Will this be an issue. I'm sure things like spinergy's and D's locks will be hard to get, but you can pay the difference. Although someone told me that with both Medicare and Medicaid you could not. Why would this matter? If the case may be why couldnt you just submit it to Medicare only?

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            #20
            I was told with medicaid you couldn't upgrade. I think its to prevent balance billing. Something like spinergys and Ds locks though you can purchase out of pocket after you've gotten the chair.
            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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              #21
              Originally posted by rollin64 View Post
              i know this may sound ignorant but how would i figure my 20% copay of like $2700. i'm awful with math, lol.
              20% of 2700 is $540. To figure it yourself (so you can look at other numbers) move the decimal on the 20(%) two spaces to the left. That gives you .20, then multiply the .20 by the number you want to get the percentage on, which is 2700 in this case. .20 x 2700 (dollars) = 540 (dollars).

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                #22
                Originally posted by PhoenixFiresky View Post
                20% of 2700 is $540. To figure it yourself (so you can look at other numbers) move the decimal on the 20(%) two spaces to the left. That gives you .20, then multiply the .20 by the number you want to get the percentage on, which is 2700 in this case. .20 x 2700 (dollars) = 540 (dollars).
                thanks a bunch, phoenix. that helped me a lot. needa go back to math school, hahaha.

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                  #23
                  so if i go thru spinlife/sportaid, they'll subtract the medicare payment and give me the total cost and tell me the medicare copayment i owe on a medicare approved chair?

                  i'm sure it'll cost more going thru a DME.

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                    #24
                    spinlife/sportaid do not accept medicaid. If you are planning on using both medicare and medicaid your chair will be paid for in full through an accepting DME. If you plan on using spinlife/sportaid AND they bill medicare (I do not know how that works) you will be left to pay the 20% on your own and submit for reimbursal with medicaid if you want. If you later submit for reimbursal with medicaid and have items medicaid will not cover (upgraded cushion, wheels, rims etc without medical necessity) you will not be reimbursed for any portion of the cost.

                    A DME experienced with billing medicare and medicaid will make sure your chair is covered in full. If there are upgrades you want that are not covered, you are free to spend your own money at spinlife or sportaid later. I'm sure this will cost you much less than going through a dealer who does not accept medicaid. Again, assuming you have both medicare and medicaid from earlier questions.
                    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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