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medicare/medicaid an manual chair?????

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    medicare/medicaid an manual chair?????

    my dme called me...outta the blue, askin if i need any new equipment. i told him i was in dy'er need of a cushion. low an behold......i'm eligible for a cushion an new manual. guess i'll be hosting my new chair thread pretty soon, haha.

    i already know my measurements, etc, etc.

    just gettin my appointment with a PT tomorrow, so....... my question?????

    how advanced will medicare/medicaid go on a high-end chair? i mentioned...titanium, he said they'll go X amount of $$$$$ on ti. i'm assumin tilite EVO is about all they'll stretch on titanium. which i'm leanin towards ti from readin threads. EVO aint real appealing though.

    he mentioned kuschall.........in that things would take forever, bein outta country, BUTT, if thats what i really wanted, he'd order it. i don't wanna go that long distance route anyways.

    anywho.....what will they pay for? considering.....invacare, quickie? top end terminator? quickie gt?

    want something nice/comfortable. i know....."DEMO" but i won't go.....A-4, GPV. like colours but 90 degree front don't agree with my legs/feet/spasms. gonna hafta get somewhere between 75/85, which might be *80*, hahaha.

    any helpage or knowledge bout ga. care/caid. i have both.

    #2
    i have a A-4 , i fixed my harley less.
    oh well

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      #3
      colours can make any frt angle u want
      Bike-on.com rep
      John@bike-on.com
      c4/5 inc funtioning c6. 28 yrs post.
      sponsored handcycle racer

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        #4
        Originally posted by fuentejps
        colours can make any frt angle u want
        dunno if medicare/caid will pay for the extra cost though.

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          #5
          nobody got a manual thru medicare/caid lately?

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            #6
            Medicare allows (pretty sure) up to 2600 for a new chair (ultra light). I don't know if Medicaid will pick up the rest of the balance for a higher end chair though.

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              #7
              If Medicaid is funding they will not allow you to pay for a differential- in their eyes, you should not have ANY extra money. In fact vendors cannot legally accept monies from medicaid clients for the purpose of paying a differential.
              Not fair- not reality but that is the game of Medicaid.

              Medicare does allow for one to pay a differential, and vendors can go so far as vend equipment and make clients sign an ABN (I think that is the form name), which makes the end user responsible if at any time Medicare arbitrarily decides not to pay for a piece of equipment recommended, needed or wanted but questionable for reimbursement. And the ridiculous part of this policy is that it may be a lack of a signature, a misdated prescription/evaluation etc, and Medicare can deny payment. In essence holding the vendor or end user hostage. (Can you tell that I am bitter over Medicare?)

              In the end it all will depend upon your primary finder as to how this can be handled. Neither is ideal in the respect that neither providers has the end user in mind. It is strictly about the bottom line, and not the the bottom so to speak. Hope this helps.
              Pam OTR/L

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                #8
                i've been browsin thru spinlife, they have the green "M" on the chairs that are medicare eligible.

                not sure if medicaid will be involved or not. i'm not wantin to pay extra, i'll be happy with whatever they pay for but i want to get the best i can get, not just the cheapest.

                can't see the PT for a couple weeks from now so i got time to figure things out. if medicare will only pay $2600 an i get a chair that costs $2500, that only leaves my DME provider making 100 bucks. how are they gonna go for that?

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                  #9
                  2600 is what Medicare will allow, but not necessarily what your DME provider will pay for the chair. They (DME provider) get the chairs at wholesale prices, then sell them for much much more. Looking for a chair for the whole 2600 will make no difference when it comes to their (your DME's) profit. Don't worry about that, they know what they are doing and they know how to make money. But...there still is the 20% copay that is up to you to pay (Medicare only). So, for a chair that cost 2600, that means you pay 520 out of pocket. You may also want to take that into consideration before buying......unless you have a secondary insurer who will pay the difference.

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                    #10
                    okay, i guess thats where medicaid kicks in (payin the other 20%). i wasn't thinkin bout em gettin them wholesale. i know on sportaid they're wayyyyy cheaper than on the manufacturers website. tis makin more sense now.

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                      #11
                      That's the part I'm not sure about. That is whether Medicaid will pay the difference or not. I don't have Medicaid, so I'm not sure what their policy is. I'm sure someone else here does though. Good luck with your new chair. I hope you find what you are looking for. :+)

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                        #12
                        Hey

                        You know I always give ya my feedback and I still LOVE my Kuschall... It took about 5-6 weeks to get my chair from the time it was ordered...And that included some items having to be changed after I ordered it...(tires/handrims/etc I wanted not avail in size I wanted....) In all honesty I don't think 5-6 weeks is all that long to wait, not that much longer than the other chair manufacturers...I've had no probs w/my chair itself...just the d*mn adjustable hardware on my roho back....I can't place it where I ultimately want it....BAH! but I'm working around that...Depending on your seat size, you may not have to get adjustable hardware for your Roho back....just don't get a "half-size" seat...LOL...
                        'Chelle
                        L-1 inc 11/24/03

                        "My Give-a-Damn's Busted"......

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                          #13
                          Any word back from medicaid?Im looking to get a colours chair through medical but I have a feeling Im not going to get one.Keep us posted
                          Not to hijack your thread but whats the diference in medical and medicaid???
                          "Independent from the rest of the sheep"

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                            #14
                            i have medicare an medicaid. i haven't paid anything for the power chairs or the cushions an backs i've gotten over the yrs.

                            i remember now........medicare pays 80% an medicaid pays the other 20%.

                            i dunno whats happnin yet. i got the doctors prescription. hadda wait 3 wks for the PT appointment (aug. 8), i believe. just don't know what they will pay for either. they changed a lot since i got my first manual in 2001. they wouldn't cover colours then, i know. he mentioned kushall an tilite but i'm sure they will only pay for the cheapest model. i would like a ti TRA but i bet they'll only go as much as EVO.

                            i'll post when i find out something.

                            Comment


                              #15
                              Originally posted by NEWPARA
                              Not to hijack your thread but whats the diference in medical and medicaid???
                              MediCal is California Medicaid...they just have a fancy name for it.....
                              'Chelle
                              L-1 inc 11/24/03

                              "My Give-a-Damn's Busted"......

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