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Getting a new chair covered by Medicare and BCBS

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  • Getting a new chair covered by Medicare and BCBS

    Hey guys and gals,

    It's been a while since my last chair and I'm really hoping to convince my insurance companies to cover another one. I'm currently in a TiLite, which will need a fair bit of repairs/replacement parts and I'm hoping insurance will just go ahead and pay for a new one.

    What's the latest rules with getting a chair covered by Medicare? Any advice on how I should phrase my request for a chair when I have my seating appointment? Do I have any hope of getting Medicare to cover a titanium chair (ZR would be ideal)?

    And last, but most importantly, how much do I have to pay out of pocket if Medicare will cover it? (I haven't met my $5000 BCBS deductible, so that won't really matter and I had medcaid on my last chair which I do not currently have). Do I have to pay 20%? Is it covered 100%?

    Thanks for your input.

  • #2
    I believe Medicare is still using the rule of 5 years for a new chair. Can't speak to the titanium, but they will only pay for the features of the chair that they consider "medically necessary" (and those at 80%), so it will be critical how your letter of medical necessity is written up (ideally by a good SCI PT or OT who knows the buzz words that will help with this).

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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    • #3
      Medicare and 5 years is correct. Titanium they do not pay for. I have read people somehow have gotten titanium paid for. And yes, they only pay for "standard" equipment. I have no idea why Medicare simply just not charge the difference Upgrade - Standard. They simply charge entire amount of upgrade.

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      • #4
        Anyone gotten an Icon approved by medicare?

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        • #5
          Medicare is only providing chairs for use "in your home". The DME will ask how tall you are and how much you weigh and briing you a Brezzy. So you have to tell them it has to be narrow to fit through the narrow door ways in your home. It has to be short so you can get to the toliet, sink, stove. If you want camber, you have to tell them its so you can reach the counter, frig, sideways and not fall over. If you want a low back, tell them you can't turn around and have to reach behind you to get the mop. You need to go to a seating clinic with a good therapist, that will say you are in danger of wrist and shoulder damage, so you need the lightest chair possible to make it easier to move, but an electric chair is too big for your home. They are wild to put people in electrics.
          Don't waste your time mentioning, you have to drive to the store to get food and toliet paper, medicare doesn't care. Hey maybe that should be their name "doesn'tcare".

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          • #6
            Originally posted by baldfatdad View Post
            Medicare is only providing chairs for use "in your home". The DME will ask how tall you are and how much you weigh and briing you a Brezzy. So you have to tell them it has to be narrow to fit through the narrow door ways in your home. It has to be short so you can get to the toliet, sink, stove. If you want camber, you have to tell them its so you can reach the counter, frig, sideways and not fall over. If you want a low back, tell them you can't turn around and have to reach behind you to get the mop. You need to go to a seating clinic with a good therapist, that will say you are in danger of wrist and shoulder damage, so you need the lightest chair possible to make it easier to move, but an electric chair is too big for your home. They are wild to put people in electrics.
            Don't waste your time mentioning, you have to drive to the store to get food and toliet paper, medicare doesn't care. Hey maybe that should be their name "doesn'tcare".
            Thanks for the advice.
            I do have a 24" door in my house (22" of clearance because of the door swing), so that shouldn't be hard to argue...

            I guess I will go with the argument that vibrations cause me pain (which is true) and thus I need a seat with suspension... ie an Icon... we'll see if I get anywhere that way.

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