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cushion and insurance

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  • cushion and insurance

    i need to get a roho cushion and i only got my chair/cushion in 2002 and blue cross covered it. i now have medicare and medicaid and need the cushion to prevent sores. i have an extremely boney bottom and they don't know why i didn't get a sore yet. i fear i will if i don't get this cushion. medicare won't cover it since it's only 2yrs old but they didn't pay for the first one. i don't have the money to pay out of pocket. i can even get a letter of medical necessity. can anyone tell what i can do?

  • #2
    First of all, don't assume that the Roho is the correct cushion for you unless you have had a computerized interface pressure study during a seating evaluation by a good therapist, on a variety of cushions.

    Then have the therapist write the letter of medical necessity for your physician to sign, and file an appeal through Medicare. They need to really emphasize the results of the seating study, and the possible consequences in $$$ information of you getting a pressure ulcer.

    Medicaid may pay for this more readily than Medicare.

    Good luck!
    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.


    • #3
      you could get an electric muscle stimulator and use it to keep your muscles (butt, etc.) in shape. i use one and i have had good results.


      • #4
        I am in the process of getting a new cushion and PT evaluation may be required. I also think it is a good idea to have this done, even if it is not required by Medicare or Medi-Cal. Try sitting in these cushions before you make your decision. Good luck.

        The test of success is not what you do when you are on top. Success is how high you bounce when you hit the bottom
        --General George Patton

        Complex problems need to be solved collectively.
        ––Paul Nussbaum