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    Kaiser Funding Titanium

    Hi all! I'm helping a friend go through the process of getting a new chair. She has Kaiser through her work and we had the first assessment at NSM (it seems Kaiser here subcontracts out to them) today. The NSM ATP said that a titanium chair isn't an option due to that one medicare rule. Since returning home I've been doing more research (and reading Oddity's comments on this thread https://www.carecure.net/forum/sci-c...-myth-or-truth). Said research has left me with two questions:

    1. When calling Kaiser, what department do we need to speak to and what questions do we need to ask to determine if "unbundling" is allowed?
    2. Has anyone gotten a titanium chair through Kaiser in the past two or so years?

    #2
    the best way i've seen to get a titanium chair is to say you can't lift more than x pounds. the doc/therapist can put that in the diagnosis to get a lighter chair.

    Comment


      #3
      Thanks, we're confident we can prove medical necessity and have receipts but the DME won't even ask Kaiser if they'll cover titanium if medically necessary.

      Comment


      • smity50
        smity50 commented
        Editing a comment
        They won't ask because they make no money on the deal. Your medical needs aren't important to them.

      #4
      I got q titanium chair with private insurance (but not Kaiser), in the end I just paid for the titanium upgrade.

      oddly enough the DME was the biggest stumbling block. Insurance okayed it relatively quickly, but I had to argue with the DME for ages and ages that yes BCBS absolutely could allow me to pay for the upgrade.

      Comment


        #5
        Private insurance generally has varied rules per plan. Unless the DME knows, because they have submitted to this specific Kaiser benefit plan before, for the same chair, they don’t know if your plan follows the Medicare guidelines, or not.

        I would call the main customer service number and ask to speak to someone about the plan’s DME benefits and the pre-approval process for wheelchairs in particular. Once there, I’d ask if they had any official policy statements about titanium frame material.

        I would also shop around for other DME providers. One willing to submit the paper work for pre-approval, regardless. Plenty will do that. Mine actually insisted on submitting (directly to Medicare, too) an “unbundled” titanium order, even after I showed him the policy statements. The denial came back citing the exact policies, of course. I posted some of that paperwork in another thread back in 2019.

        Don’t just take this one shop’s word for it. There are DME folks out there willing to put in some effort to make a sale.
        "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

        Comment


        • funklab
          funklab commented
          Editing a comment
          This is a good actionable plan.

          First step is to get approval from Kaiser. This is 100% on you, zero chance the DME is going to help. It’s probably going to taken dozens and dozens of phone calls and 30-40 hours of your time.

          You need the name and contact info for the person at Kaiser who approves it, because DME isn’t going to believe you. Then you basically have to facilitate communication between the two of them. Tell the DME to talk to the Kaiser rep. Ask the Kaiser rep if they heard from DME, have them call DME back. Ask for DME supervisors number and have them call Kaiser and back and forth and back and forth for several months.
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