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Medicare and push handles?

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    Medicare and push handles?

    Has anyone heard of medicare refusing to pay for push handles on a wheelchair?

    I've been helping an online friend get her first wheelchair. An Icon. She received it today, but there are a LOT of problems. One of them is it showed up with no push handles. She was told 2 separate excuses, one of them was that the dealer didn't think she really needed them and removed them from the order. She was also told that since medicare only cares about wheelchair use in the house, they won't pay for them. They're around $235 I believe on the Icon order form.

    She's really lucky she HAS an Icon considering the mistakes the dealer has made. She is SWIMMING in the chair, and she complained repeatedly when they delivered the chair and yet they kept telling her she was fine and only adjusted the wheel spacing, would not adjust the chair width. I think part of the reason may have been a combination of laziness and the fact they'd brought a size 16 cushion for her to demo, so maybe they had no other cushion options right now. Speaking with her she said she's swimming in the chair and expressed that she cannot propel it at ALL right now, and feels as if her shoulders are going to dislocate when she tries. The current seat pan on the chair is the narrowest at 14, but she's a size 0 and it sounds as if she may need narrower! She's now thinking she remembers the OT to have measured her around 12 wide. It shouldn't be an issue to swap out the seat pan with Icon, but of course if she needs such a drastic change the backrest will have to be swapped as well. She currently has a comfort company Acta back.

    Any suggestions? She's going to email the OT about the problems and changes the dealer made from what was agreed upon. The chair was also supposed to come with a headrest and didn't. She's going to take photos so I can get a better idea of what parts are currently on the chair. And I told her she should contact insurance and tell them to not pay until this has been resolved, that the chair she has received is NOT the chair that was ordered.
    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.

    #2
    For Medicare, medical necessity for use "in the home" is all that's considered.
    Somehow, there needs to be documentation that, without push handles, your friend would not be able to do basic home ADL's because she can't get to her bathroom, kitchen, bedroom, etc.
    One way to do this, since she cant use the push handles herself, is to have documentation that push handles would facilitate your friend's caregiver in moving her around the home to the bathroom for bathing, grooming, toilet, getting her to an area to dress, getting her to the kitchen/dining room for eating and getting her to the bedroom for sleeping.
    Anything involving a friend or caregiver using the push handles to do outside activities would likely be denied.
    Awful? Yep.

    Comment


      #3
      Yes, I stated that medicare only cares about in home. But medicare is paying for her smart drive. She obviously needs assistance in the home, so how could they deny push handles? Its not about documenting WHY she needs the push handles, but if its possible for medicare to completely refuse to pay for push handles flat out for anyone or on a specific chair. She definitely needs them, there's no doubt about that. And I call bullshit on it not being possible for medicare to cover them.

      The DME didn't say that medicare denied her push handles. They said they WOULD deny push handles because medicare only cares about in home use. I believe they're lying to her to cover their own ass. Especially since she was given more than one excuse for the chair showing up without push handles.

      Not to mention its totally NOT OK for the dealer to just make changes to the chair without having discussed them prior to the chair being ordered.
      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.

      Comment


        #4
        You're being a great advocate for your friend. You're right, the dealer should not have made those changes without disclosing them in writing.

        Now please understand the following statement is not my opinion. This is just me looking through the eyes of a line item insurance reviewer going over your friend's chair components. I'm agreeing to pay for a $6,400 Smart Drive to facilitate independent home mobility. Why am I doubling down on the $235 push handles ?

        Comment


          #5
          Exactly. Medicare admits she is unable to independently propel herself around the home and willing to pay thousands to power assist. So why would they refuse to pay a couple hundred for push handles for someone to move her around? And the smart drive power assist still requires she participate in propelling herself. So at any times when she's completely unable to propel herself at all, the push handles would be required for someone to assist her.

          It makes me so angry. She asked if the mistake with the chair being too wide (mis-measurements) was common. I said unfortunately, yes. Very common. If she hadn't been able to get the Icon approved, she'd have ended up with a completely useless chair, that any attempt to use would have been physically damaging. And in this case its because the dealer changed things after the OT measured her. Because the Icon she demoed was adjusted much smaller and fit well. Think about all the people that don't even have the opportunity to see an OT first
          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.

          Comment


            #6
            Medicare does pay for push handles. DME is lying to cover negligence. She can justify them as positioning devices (depending on her level of SCI), as well as essential for caregivers. How DMEs can stay in business with this kind of service is crazy. Manufacturers should not allow representatives like these to handle their products, because of physical liability and how poorly it presents their product.

            Comment


              #7
              DME has been cut so bad......they pay so little so you get this kind of help. People who don't give a dam get paid 12 hour.

              Try and get something fixed today......good luck with that.
              Art

              Comment


                #8
                Yes Medicare does pay for push handles. They must be made of the material Medicare is covering. From what you wrote, it sounds like the dealer is a real problem.

                Comment


                  #9
                  It really sounds like the dealer screwed up. How dare they change an order without permission of the customer. It should be a requirement that the customer signs off on an order before it is sent in, not just the dealer! This must be so frustrating for her, not to mention time consuming, stressful and unsafe.

                  Originally posted by ~Lin View Post
                  Not to mention its totally NOT OK for the dealer to just make changes to the chair without having discussed them prior to the chair being ordered.
                  I think getting the OT involved is a really good idea, along with insurance as you suggested. She should definitely not accept delivery of this chair until it meets her requirements as ordered. If she has not already done so, I think she should put in a formal written complaint to the DME with full documentation, and then possibly also to Medicare if they do not respond appropriately. See Complaints about durable medical equipment (DME), and note they must give a response in writing within 14 calendar days.

                  She's going to email the OT about the problems and changes the dealer made from what was agreed upon. The chair was also supposed to come with a headrest and didn't. She's going to take photos so I can get a better idea of what parts are currently on the chair. And I told her she should contact insurance and tell them to not pay until this has been resolved, that the chair she has received is NOT the chair that was ordered.
                  About the push handles, can she give a reason something like the SmartDrive can not be attached during bathroom ADL activities because of space or that she needs push handles for while the SmartDrive is being charged or if there is a power outtage?
                  Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

                  Comment


                    #10
                    She has the chair right now. I think they rushed her along with delivery, she was talking to me while waiting for them to arrive. All excited about the delivery, then left when they got there. When she came back and messaged me about the problems I was surprised she was back so quickly. She didn't know what to do to advocate for herself further.
                    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.

                    Comment


                      #11
                      I find it very sad when DME's treat people like this. I hope you friend reads these posts also. Knowledge is so important, because the reality is that most people using complex rehab technology need to fight hard to get what they need.
                      Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

                      Comment


                        #12
                        I think it's critical that the OT gets involved. In fact, your friend really should talk to the OT and arrange an appointment for OT to review friend in the chair, as well as help deal with the vendor.
                        This requires prompt action, as vendor may try to avoid situation.
                        If your friend is unable to advocate independently, your help as well as the OT, and maybe even ICON, will help resolve the problems.

                        Comment


                          #13
                          Actually, we were also told Medicare does deny push handles, and my father also had them denied. We appealed twice after they were denied (other things were denied as well) and lost. If the other posters know that Medicare does cover push handles, then hopefully they can post what needs to be documented so that they will get covered.

                          It is very common for DME's to not order components when they suspect that Medicare will deny them, so this doesn't surprise me. To some degree you can't blame them as they are worried they will not get paid. But it is not acceptable for them not to explain they are not going to order them, or to not offer you the option of signing an ABN. My Dad's DME was AWFUL and they were only willing to order push handles because we signed an ABN (advanced beneficiary notice) saying that we would pay out of pocket for anything Medicare denied. Fortunately, his secondary insurance actually picked up the cost in the end.

                          There were crazy things that Medicare denied on my Dad's wheelchair that don't make sense. They paid for his Tilite frame, and his Power Assist eMotion wheels, but they denied the upgrade to the axel that was necessary so that the wheels would fit safely on the frame. Totally irrational. Again - we appealed it TWICE (this took almost a year), and lost. It is what it is....

                          What stinks is that it is usually cheaper to buy components on your own online rather than through the DME if you know they are going to be denied. But if there is a CHANCE they might be covered by Medicare and you want to have the DME give a claim a try. It is a risk.... that you may have to pay for. It frustrates me to no end.

                          Comment


                            #14
                            Medicare is getting worse if you read the next thread on this Forum:

                            http:///forum/showthread.php?251344-...hnology-in-USA
                            You will find a guide to preserving shoulder function @
                            http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

                            See my personal webpage @
                            http://cccforum55.freehostia.com/

                            Comment


                              #15
                              Where I live in the Netherlands you have a choice to fund equipment similar to how Medicare works or you can get a budget and make your own decisions. It's a lot of work and takes a long time to get approved, but once you get approval on a budget based on requirements, you can choose where and how you want to use the budget. It's even worse in Europe for mark-up on equipment, and by purchasing much of it online in the US, even with shipping we were able to save 40-50%, which allowed us to go for upgrades on everything and have spares. Although it has it's problems, like less than informed "advisors" who determine the budget, it's a good way to go for people who know what they need and how to get it, and makes for a more competitive environment. I think it's a shame that Medicare does not consider this option, because it would probably serve both the customers and taxpayers well.

                              N.B. It also funded the seat base that the less than competent advisor forgot to include

                              Originally posted by hlh View Post
                              What stinks is that it is usually cheaper to buy components on your own online rather than through the DME if you know they are going to be denied. But if there is a CHANCE they might be covered by Medicare and you want to have the DME give a claim a try. It is a risk.... that you may have to pay for. It frustrates me to no end.
                              Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

                              Comment

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