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New Wheelchair with Highmark BCBS

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  • New Wheelchair with Highmark BCBS

    Does anyone know how often you can get a new wheelchair with Highmark Blue Cross Blue Shield? When I got my wheelchair about 4 years ago, rehab told me that it was every 5 years. I called Highmark today to check and the girl I spoke with told me that there wasn't a specific time frame. She said as long as it was medically necessary it would be covered. That doesn't sound correct to me. Obviously it is medically necessary. That doesn't mean I can get a new wheelchair every day. So I'm kind of confused by this. Anyone have any suggestions?

  • #2
    If your old one is causing issues you can occasionally get a new one sooner. Ex its too small and rubbing your legs causing a sore, etc.
    If you can't handle me at my worst, then you sure as hell don't deserve me at my best.


    Sometimes it is easier to widen doors than it is to open minds.

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    • #3
      I believe she means medically necessary to have a NEW wheelchair, not medically necessary to USE a wheelchair. Like addiesue said if something was wrong with your current chair it sounds like your insurance would cover a new one even if it hadn't been long since you got the one you have.
      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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      • #4
        Originally posted by tarantella View Post
        Does anyone know how often you can get a new wheelchair with Highmark Blue Cross Blue Shield? When I got my wheelchair about 4 years ago, rehab told me that it was every 5 years. I called Highmark today to check and the girl I spoke with told me that there wasn't a specific time frame. She said as long as it was medically necessary it would be covered. That doesn't sound correct to me. Obviously it is medically necessary. That doesn't mean I can get a new wheelchair every day. So I'm kind of confused by this. Anyone have any suggestions?
        If they are like Aetna, I was able to get a new chair a year after my original one. My original chair was fitted for me in rehab while I was wearing a TLSO. It was way too big, combined with the weight of transferring into my car giving my bursitis in my elbow I got approval for an ultra light chair (ZRA) as opposed to the chair I had (AeroZ). Just needed a PT to write the reason and a doctor to sign it. In other words you would need some change in your physical condition or other reason to get a chair before 5 years.

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        • #5
          Yes you need a drastic change in your medical condition so much so that the cost of upgrading your current ride would cost more than a new chair and/or the parts to retrofit your current chair do not exists.

          And also they have pretty successfully pushed that general rule of 5 years out to 7 to 9 years. And the new system and payment for chairs is criminal insurance companies follow medicare/Medicaid policy closely and there policy is currently reimbersement paid for your chair will be the price of the lowest selling price on the internet for a comparable chair on the day your paperwork gets approved so if you don't have secondary coverage you can end up eating a large bill for a new chair. YMMV

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          • #6
            we are getting a new chair for my son after 2 1/2 years. I think the 5 year rule was a general guide, maybe the insurance companies are starting to understand that is unrealistic and each case is different.

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