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Finally gonna try to use Medicare to get a chair

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  • #16
    Originally posted by t8burst View Post
    I have only gotten chairs from private insurance not medicade, but it is my understanding that private insurers use the same criteria. I was able to get a TR3 paid for because I get in and out of my car quite a bit during the day and am developing shoulder problems (the latter also got me a smartdrive). Not sure if it is relevant, but you never know.
    my private ins always covers my tilites tr3/zr. i think the issue is the amount they cover
    Bike-on.com rep
    John@bike-on.com
    c4/5 inc funtioning c6. 28 yrs post.
    sponsored handcycle racer

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    • #17
      Originally posted by t8burst View Post
      It might be harder for you not having a complete injury.
      complete or incomplete shouldn't and dosen't matter.
      T6 Incomplete due to a Spinal cord infarction July 2009

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      • #18
        Originally posted by Smashms View Post
        complete or incomplete shouldn't and dosen't matter.
        Shouldn't is the opinion of the consumer, but it is the insurance companies that would be the ones that decides the doesn't

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        • #19
          I've had great results in getting titanium wheelchairs approved. Not so much in actually getting the chair.

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          • #20
            Good luck on the journey...you sure you didn't get the ex-J&J Ibot salesman there? lol Those grandiose claims of insurance approval expertise sure sound familiar

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            • #21
              I should know this by now.
              What is the most $$ Medicare(80%) will pay for the basic ultralight chair (K0005) without any of the extra add on HCPCS
              (Healthcare Common Procedure Coding System) K codes ?
              Is there a source somewhere online for the amount the DME gets for the K codes?
              It's about $2000.00 I believe.

              Be interesting to see a comparison of which K codes each DME uses when getting reimbursement for folks chairs too.

              K0020 - Fixed, adjustable height armrest, pair
              K0040 - Adjustable angle footplate, each

              etc..

              https://hcpcs.codes/k-codes/

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              • #22
                The allowable for K0005 is indeed ~$2000. It varies by state. In VA it's ~$2050 this year. CMS has the DME Fee Schedule available for download on their main site.

                https://www.cms.gov/Medicare/Medicar...-Schedule.html

                Medicare always send a EoB explaining what they were billed for and what they paid.

                The further down this rabbit hole I get the more I'm suspecting DME retailers shenanigans when it comes to titanium chairs. They're all coded the same, and TiLite's chairs all have current classification under K0005. I don't think Medicare cares since they're paying out the $2,050 no matter what chair you medically qualify for under K0005. You know who does care? Manufacturers and DMEs. I don't think it's an accident that getting a ZR is now an upgrade to the base ZRA. Medicare DOES care about upgrades.



                Originally posted by NW-Will View Post
                I should know this by now.
                What is the most $$ Medicare(80%) will pay for the basic ultralight chair (K0005) without any of the extra add on HCPCS
                (Healthcare Common Procedure Coding System) K codes ?
                Is there a source somewhere online for the amount the DME gets for the K codes?
                It's about $2000.00 I believe.

                Be interesting to see a comparison of which K codes each DME uses when getting reimbursement for folks chairs too.

                K0020 - Fixed, adjustable height armrest, pair
                K0040 - Adjustable angle footplate, each

                etc..

                https://hcpcs.codes/k-codes/

                "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

                "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

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                • #23
                  I use to have an Tilite Aero X and the Tilite Aero Z looks pretty good. Both these chair should be covered. I normally just pay cash for my chairs, no way would medicare cover the carbon fiber chair I currently use as it was 4500 bucks.
                  "Life is about how you
                  respond to not only the
                  challenges you're dealt but
                  the challenges you seek...If
                  you have no goals, no
                  mountains to climb, your
                  soul dies".~Liz Fordred

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                  • #24
                    I just used Medicare to get a wheelchair. I am on Aetna Medicare Advantage, but it doesn't really matter if you have straight Medicare or an Advantage plan. Either way they are going to pay 80% of the approved cost. I worked with NuMotion (not my first choice) but they are in network. I had to first go the the Dr. to get a prescription, then a physical therapist, with the therapist NuMotion speced out the chair and now it is back to the Dr. for a signature. It is a Tilite Areo Z. NuMotion informed me that Medicare will not approve a titanium chair. This is also including a Smart Drive. I don't know what my out of pocket will be yet, but the first estimate is $1400.

                    Mark

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                    • #25
                      Originally posted by Curt Leatherbee View Post
                      I use to have an Tilite Aero X and the Tilite Aero Z looks pretty good. Both these chair should be covered. I normally just pay cash for my chairs, no way would medicare cover the carbon fiber chair I currently use as it was 4500 bucks.
                      Hey Curt,

                      You have a 4.5K carbon fiber chair? Can you send a link to the companies website?

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                      • #26
                        Motioncomposites.com
                        "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

                        "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

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                        • #27
                          Got my FIRST call back from the DME guy yesterday. 3 months later. I deliberately didn't call them just to see if the horror stories of dealing with DME vendors might happen. 3 months. They said at the seating eval they'd call me in a couple weeks. Wow. I'm not hurting for a new chair, so I'm in no rush, but sheeeeeesh. Of course, we're starting over because it apparently it took then 3 months for figure out everything I told them during the eval was true. Unbelievable. Yet, totally believable. Heading back to the doctor this morning to get a new script for an appropriate chair and correct letter of medical necessity to match my needs. Back to square one. LOL!! "Here we go 'round the mullberry bush! The mulberryBush! The mulberrybush!"
                          "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

                          "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

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