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My TiLite TR3 / Insurance Approved FINALLY

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    My TiLite TR3 / Insurance Approved FINALLY

    ...but with a hitch (Aetna). They don't want to pay for the Spinergy LX wheels. What good is a chair without the wheels?

    My DME suggested I go with the Golz Twin-Star Exchange Wheel since TiLite is offering them at no cost. Has anyone had any long term experience with these wheels? If so, what is your opinion? Should I push for the Spinergy LX wheels?

    I'll be sure to post photos once I get the chair. Hopefully sooner rather than later.
    Last edited by ResonantEcho; 17 Mar 2013, 11:43 PM.
    -ResonantEcho - T6/T7 Complete - October 31st, 1986

    #2
    Congrats ! I personally like the look of both sets of wheels. I have LX's on both of my chairs, but enjoy the look of the other one.
    www.adventuresofcolinandheather.blogspot.com !

    Comment


      #3
      Originally posted by ResonantEcho View Post
      ...but with a hitch (Aetna). They don't want to pay for the Spinergy LX wheels. What good is a chair without the wheels?

      Weight was not an isue for me, so I was glad to accept an AeroZ with heavy aluminum accessories and stock Spinergy wire wheels. If Aetna approved the TR because of a weight issue (even partially), I would think they should pay for the Spinergy LX.
      Chas
      TiLite TR3
      Dual-Axle TR3 with RioMobility DragonFly
      I am a person with mild/moderate hexaparesis (impaired movement in 4 limbs, head, & torso) caused by RRMS w/TM C7&T7 incomplete.

      "I know you think you understand what you thought I said, but what I don't think you realize is that what you heard is not what I meant."
      <
      UNKNOWN AUTHOR>

      Comment


        #4
        Originally posted by ResonantEcho View Post
        ...but with a hitch (Aetna). They don't want to pay for the Spinergy LX wheels. What good is a chair without the wheels?

        My DME suggested I go with the Golz Twin-Star Exchange Wheel since TiLite is offering them at no cost. Has anyone had any long term experience with these wheels? If so, what is your opinion? Should I push for the Spinergy LX wheels?

        I'll be sure to post photos once I get the chair. Hopefully sooner rather than later.
        Free does raise ones doubts, but these wheels look good and are worth considering. I can't find their weight to make that comparison though if that is a concern.
        I have had periodic paralysis all my life. I lost my ability to walk in 2011 beginning with a spinal block, which was used for a hip fracture caused by periodic paralysis.

        Comment


          #5
          Originally posted by ResonantEcho View Post
          My DME suggested I go with the Golz Twin-Star Exchange Wheel since TiLite is offering them at no cost.
          Wow. Really? These are normally an $895 upgrade. I would double check with the DME. I like the looks of them but have no personal experience.

          E
          Last edited by Essie; 18 Mar 2013, 6:21 PM. Reason: poor English
          There is no such thing as a stupid question but there sure are a lot of inquisitive idiots. -modified from despair.com

          Comment


            #6
            Originally posted by nonoise View Post
            Free does raise ones doubts, but these wheels look good and are worth considering. I can't find their weight to make that comparison though if that is a concern.
            According to Out-Front the weight is 3.56 lbs for a pair of 24".
            -ResonantEcho - T6/T7 Complete - October 31st, 1986

            Comment


              #7
              Originally posted by Colin83 View Post
              Congrats ! I personally like the look of both sets of wheels. I have LX's on both of my chairs, but enjoy the look of the other one.
              Thanks, Colin. I can't wait to be sitting in a new chair. I'm hoping the measurements are more to my liking this time.
              -ResonantEcho - T6/T7 Complete - October 31st, 1986

              Comment


                #8
                Originally posted by chasmengr View Post
                Weight was not an isue for me, so I was glad to accept an AeroZ with heavy aluminum accessories and stock Spinergy wire wheels. If Aetna approved the TR because of a weight issue (even partially), I would think they should pay for the Spinergy LX.
                Weight isn't really an issue for me as well. Luckily I have plenty of strength in my upper body. However, age is catching up with me. I've been experiencing pain here and there in my elbows and shoulders. Then again, it may be a result of the chair I'm currently in (Top End Titanium). It's been a good chair for 10 years but I'm constantly having to adjust the camber bar, replace breaking spokes every month or so (Spinergy), etc. Also, wasn't perfectly measured for me. I'm hoping the new chair will take care of that.
                -ResonantEcho - T6/T7 Complete - October 31st, 1986

                Comment


                  #9
                  Originally posted by Essie View Post
                  Wow. Really? These are normally an $895 upgrade. I would double check with the DME. I like the looks of them but have no personal experience.

                  E
                  I'm assuming that is the case. When I received an email from ATG Rehab letting me know everything had been approved but the wheels the person who measured me responded a few minutes later. He said if they refuse to pay for the Spinergy wheels TiLite was offering the Golz Twin-Star wheels at no cost. They look nice and sturdy, but I wanted to see if anyone here has been using them for their everyday wheels.
                  -ResonantEcho - T6/T7 Complete - October 31st, 1986

                  Comment


                    #10
                    Originally posted by ResonantEcho View Post
                    ...but with a hitch (Aetna). They don't want to pay for the Spinergy LX wheels. What good is a chair without the wheels?

                    My DME suggested I go with the Golz Twin-Star Exchange Wheel since TiLite is offering them at no cost. Has anyone had any long term experience with these wheels? If so, what is your opinion? Should I push for the Spinergy LX wheels?

                    I'll be sure to post photos once I get the chair. Hopefully sooner rather than later.
                    I have aetna as well. They are weird about what they will pay for. I could get the High CF Jetstream back or the Low one but not the mid one. I would push for the LX wheels, I got them to pay for them.

                    ETA: It is interesting you said pain in your elbow. That is how I got approved for a K5009 (I think that is it) chair. CF camber tube, lightweight everything. I was getting bursitis in my elbow from xfering my AeroZ (getting old is a bitch).

                    Comment


                      #11
                      Originally posted by t8burst View Post
                      I have aetna as well. They are weird about what they will pay for. I could get the High CF Jetstream back or the Low one but not the mid one. I would push for the LX wheels, I got them to pay for them.
                      They've definitely been a pain in the butt. The first time they denied the chair they were wanting to know why I couldn't replace parts on my current chair.

                      What did you have to do to get them to agree (LX Wheels)? Or did you let your DME handle it?
                      Last edited by ResonantEcho; 22 Mar 2013, 1:37 PM.
                      -ResonantEcho - T6/T7 Complete - October 31st, 1986

                      Comment


                        #12
                        Originally posted by t8burst View Post
                        ETA: It is interesting you said pain in your elbow. That is how I got approved for a K5009 (I think that is it) chair. CF camber tube, lightweight everything. I was getting bursitis in my elbow from xfering my AeroZ (getting old is a bitch).
                        To be honest I'm not sure why my right elbow started hurting so bad. It hurt just to lift a glass of water. It finally went away for the most part after 4 months or so. However, now my left elbow has started. I'll go through the same thing with my shoulders from time to time.

                        So yes. Getting old SUCKS. I'm sure part of the problem is I don't work out as diligently as I used to. If I can get back to lifting and stretching on a consistent basis I'm sure that will help.
                        -ResonantEcho - T6/T7 Complete - October 31st, 1986

                        Comment


                          #13
                          Gotta love insurance. Chair has been approved but not the titanium frame or Spinergy LX wheels. Amongst other items (some of which I expected).

                          Our decision
                          An Aetna medical director reviewed all supporting documentation submitted. After this review, we determined that the proposed TiLite TR series 3 and accessories except those on the denied service would be eligible under the member's insurance plan. This may change if the clinical information changes.

                          However, it has been determined that the proposed Spinergy LX would not be eligible under the member's insurance plan, assuming all of the clinical information remains unchanged. Aetna considers upgraded and specialty wheels (e.g., Spinergy) are considered not medically necessary because they are not required for performance of instrumental activities of daily living. In addition, under the plan, benefits for the proposed sideguards, titanium frame, anodiozed package, seat pouch and luggage carrier are not covered.

                          This decision was made utilizing Aetna's Clinical Policy Bulletin (CPB) 0271. You may obtain a copy of this CPS through the internet at www.aetna.com.
                          -ResonantEcho - T6/T7 Complete - October 31st, 1986

                          Comment


                            #14
                            How do they approve a TR3 without approving a titanium frame??
                            Chas
                            TiLite TR3
                            Dual-Axle TR3 with RioMobility DragonFly
                            I am a person with mild/moderate hexaparesis (impaired movement in 4 limbs, head, & torso) caused by RRMS w/TM C7&T7 incomplete.

                            "I know you think you understand what you thought I said, but what I don't think you realize is that what you heard is not what I meant."
                            <
                            UNKNOWN AUTHOR>

                            Comment


                              #15
                              Originally posted by chasmengr View Post
                              How do they approve a TR3 without approving a titanium frame??
                              It's obvious they have no clue.

                              I'm sure my DME will take care of it.
                              -ResonantEcho - T6/T7 Complete - October 31st, 1986

                              Comment

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