Medicare Coverage For Duarble Goods Update

[tinkerbella]

I was given a script for a WALKER and WHEELCHAIR and told you can't get both at the same time and mentioned this and couldn't find the post so I'm just going to make it brief. I had to pay upfront 189.00 for a fancy smacy walker purliebule with a basket and brakes. I felt like it was my first bike. I thought the woman said I would be reinbursed in full by medicare/medicaid. Brain fog, I was having a major life decision going on picking out my new set of wheels and had been standing too long. The check came from medicare today 106. 18. I called the store she gets annoyed with me and tells me we told you that. I had told them that Walgreens had them on sale for 99.00 that week when I was at the store and they told me well they take care of all the paper work, so I went along with them.

I can't do math, never could and ask her so will I get more back from medicaid? She is annoyed again and gets off the phone and comes back and say maybe if they want to pay another 26.73. I tell her they are sussose to pay what medicare doesn't pay.

That's not what I was told and I had people with me.

Now I have to get a WHEELCHAIR and want one live someone here has purple, that don't have that so they want to find out who you are. Earth Mother was it you? I need to know is it a light weight, legs move up and down, are you exercise intolerant? Do you get tachy pushing yourself?

then she tells me I should get a PT EVAL BEFORE GETTING EQUIPTMENT TO BE SURE IT'S RIGHT FOR YOU, as usually with medicare they will only give you the standard and it's rented for a year and then you graduate to the light weight. Ok

next, I hate to admit the next, I'm falling in love (not) down so making it to the bathroom really hit me hard when I landed in the sink when I passed out here last night. I need a COMMODE, yes by my bed. I will have a nice write up on match.com, now wont I. Maybe I can make a nice cover out of sheets I love to decorate whith sheets. Guess what , they are covered as long as they are by your bed. Remmember that now.

Next item SHOWER CHAIR,, none of those items are covered at all. $49.94 for a SHOWER STOOL. I'll continue to sit on the floor of the shower.

COMPRESSION HOSE, now was it green who said they were covered by medicaid? Well, it all depends on the day you are there and who you are talking to as all my other items may be covered by Soft ortho provider that takes your state insurance.

cHECK YOUR STATE GUIDELINES FOR THESE MA HAS THEM:

If you have medicaid and disabled you can also get rides to you doctors with a PT1 form most don't know how to fill them out. You doc must apply and then you have to be approved. I have learned how to do all of this. The doctor is suppose to fill the whole thing out, but they don't know how. We need to be advocates for ourselves and others who are unable. It is like a script only to get you to the services you need. Have your provider go online to your state website. If they do this online it takes them 30 mins to process. By paperwork 48 hours, I have had to teach all my Pots docs how to do this on paper, next will be online as once you are enrolled everything is easy after that.

Also many state insurances will reininburse you for you travel expensives, look into that. Many people don't know that, as they would rather pay you than hire a cab company.

I hope this was helpful to those who have medicare primary and medicaid secondary.

It really sinks after working your whole life to be left with this insurance, but it's better than nothing.

FOR THE PART D DRUG PART, I'm so glad I got AARP, BEING DISABLE MAKES YOU ELEGIBLE, YOU DON'T HAVE TO BE A SENIOR! you get to be in any plan that fits your drug needs. I chose the premium plan and pay for it It has been worth every penny. I think next year I'll bump it up the the next level so all vitamins are covered. I hope you know if you are declared disabled by the state you are able to change your part D drug plan monthly if you wanted. I have already hit ) co payments so I'm not swithing a thing and they have covered everything.

I''VE HAD TO LEARN THE HARD WAY, SO I THOUGHT I WOULD SHARE ALL OF THIS.

Blessings and Love to all~

BellaMia~

[flop]

I have a purple wheelchair but I think it will be EarthMother's that you have read about recently.

I was very lucky to get my chair paid for by "access to work" a UK government fund to help disabled people stay in work. Mine is an ultra-lightweight titanium chair made to measure for me and worth about $6000!

Flop

[Broken_Shell]

Hi,

I live in Wisconsin and just got approved for a wheelchair at total coverage through Medicare and Medicaid. I worked with a company that processed everything through my insurance after I submitted my doctor's prescription and diagnosis information. I didn't pay anything up front and the company representative was very helpful in showing me wheelchair options and talking about coverage. I just got the news about the prior authorization last week, and hope to have the chair by early August... and yes, I got to choose a color and I went with green!

~ Broken_Shell

[EarthMother]

Wow what a wealth of knowledge about medicare. Thanks for sharing your experience.

I do have a purple wheelchair with raising leg rests. It is a light weight not an ultra lightweight. I lost my rented wheelchair when we had to switch from an HMO to a PPO this year. So I charged it (I think it was around 500) to my high deductible. I am very exercise intolerant but only when upright. That is to say, I can do my 80 ab crunches on the floor -- no problem. Cool thing for me about the chair, is if my feet are raised (or pretzel twisted) my pulse still goes up a bit when I push myself but it doesn't feel bad like when it raises that high and I am standing still. It took me some months to get my upper body in shape but now I have no problem propelling on my own power.

I keep the chair in the car and only use it when I go out. But it would have been a big help last summer when I couldn't make it to the bathroom on my own and had to have my husband push me in an office chair -- or use a jury-rigged pot by the bed. Ick.

[tinkerbella]

Thanks EM,

Could you list the model # and the company as the medical store said they would see if they could get it. I may have to pay extra for it. I'm really having a problem getting tachy.

Thanks

BellaMia~

If I'm going out it's in style!

[tinkerbella]

Hi,

I live in Wisconsin and just got approved for a wheelchair at total coverage through Medicare and Medicaid. I worked with a company that processed everything through my insurance after I submitted my doctor's prescription and diagnosis information. I didn't pay anything up front and the company representative was very helpful in showing me wheelchair options and talking about coverage. I just got the news about the prior authorization last week, and hope to have the chair by early August... and yes, I got to choose a color and I went with green!

~ Broken_Shell

Hi ~Broken_Shell : )

If you could let me know here also the company that the they order from they said they would be able to probably help me.

I have to have color to look cool to my grand kids! Was yours light weight? Because they said usually they make you graduate up to light weight. that's when she recommended the PT referral.

Anyone else with suggestions let us know as many of us will need to know these answers one day. I went to the biggest store in the area and thought with the walker, being fancy smancy I thought it was going to be alright.

Now I wish I had an PT eval for the walker as I have nerve damage in my hands and arms and the woman didn't help me at all she was more involved with other customers Now I wonder if that grip will be too much on my hands.

so lesson learned here. My doctor had never had to dispense these items before. They are learning through me, as Pots is new in the suburbs. I was blessed to even be dxed by my cardio.

Thanks everyone~

BellaMia~

[EarthMother]

Thanks EM,

Could you list the model # and the company as the medical store said they would see if they could get it. I may have to pay extra for it. I'm really having a problem getting tachy.

Thanks

BellaMia~

If I'm going out it's in style!

http://www.spinlife.com/Invacare-9000-XT-C...m?productID=115

[tinkerbella]

Thanks EM

Those are nice, I have to see if they will pay. Have a wonderful day!

BellaMia!

[somemonkey]

I was given a script for a WALKER and WHEELCHAIR and told you can't get both at the same time and mentioned this and couldn't find the post so I'm just going to make it brief. I had to pay upfront 189.00 for a fancy smacy walker purliebule with a basket and brakes. I felt like it was my first bike. I thought the woman said I would be reinbursed in full by medicare/medicaid. Brain fog, I was having a major life decision going on picking out my new set of wheels and had been standing too long. The check came from medicare today 106. 18. I called the store she gets annoyed with me and tells me we told you that. I had told them that Walgreens had them on sale for 99.00 that week when I was at the store and they told me well they take care of all the paper work, so I went along with them.

I can't do math, never could and ask her so will I get more back from medicaid? She is annoyed again and gets off the phone and comes back and say maybe if they want to pay another 26.73. I tell her they are sussose to pay what medicare doesn't pay.

That's not what I was told and I had people with me.

Now I have to get a WHEELCHAIR and want one live someone here has purple, that don't have that so they want to find out who you are. Earth Mother was it you? I need to know is it a light weight, legs move up and down, are you exercise intolerant? Do you get tachy pushing yourself?

then she tells me I should get a PT EVAL BEFORE GETTING EQUIPTMENT TO BE SURE IT'S RIGHT FOR YOU, as usually with medicare they will only give you the standard and it's rented for a year and then you graduate to the light weight. Ok

next, I hate to admit the next, I'm falling in love (not) down so making it to the bathroom really hit me hard when I landed in the sink when I passed out here last night. I need a COMMODE, yes by my bed. I will have a nice write up on match.com, now wont I. Maybe I can make a nice cover out of sheets I love to decorate whith sheets. Guess what , they are covered as long as they are by your bed. Remmember that now.

Next item SHOWER CHAIR,, none of those items are covered at all. $49.94 for a SHOWER STOOL. I'll continue to sit on the floor of the shower.

COMPRESSION HOSE, now was it green who said they were covered by medicaid? Well, it all depends on the day you are there and who you are talking to as all my other items may be covered by Soft ortho provider that takes your state insurance.

cHECK YOUR STATE GUIDELINES FOR THESE MA HAS THEM:

If you have medicaid and disabled you can also get rides to you doctors with a PT1 form most don't know how to fill them out. You doc must apply and then you have to be approved. I have learned how to do all of this. The doctor is suppose to fill the whole thing out, but they don't know how. We need to be advocates for ourselves and others who are unable. It is like a script only to get you to the services you need. Have your provider go online to your state website. If they do this online it takes them 30 mins to process. By paperwork 48 hours, I have had to teach all my Pots docs how to do this on paper, next will be online as once you are enrolled everything is easy after that.

Also many state insurances will reininburse you for you travel expensives, look into that. Many people don't know that, as they would rather pay you than hire a cab company.

I hope this was helpful to those who have medicare primary and medicaid secondary.

It really sinks after working your whole life to be left with this insurance, but it's better than nothing.

FOR THE PART D DRUG PART, I'm so glad I got AARP, BEING DISABLE MAKES YOU ELEGIBLE, YOU DON'T HAVE TO BE A SENIOR! you get to be in any plan that fits your drug needs. I chose the premium plan and pay for it It has been worth every penny. I think next year I'll bump it up the the next level so all vitamins are covered. I hope you know if you are declared disabled by the state you are able to change your part D drug plan monthly if you wanted. I have already hit ) co payments so I'm not swithing a thing and they have covered everything.

I''VE HAD TO LEARN THE HARD WAY, SO I THOUGHT I WOULD SHARE ALL OF THIS.

Blessings and Love to all~

BellaMia~

My wheelchair was payed by Medicaid in full. And it reclines.

[tinkerbella]

somemonkey,

hey, that is great to know, thanks for telling me. i saw my doctor this morning and I'm his first to need a wheelchair. I was telling him how I thought I needed a ultra light and an PT eval. He agreed, so I said I just have the Pain clinic get me one. he said no, i want you to have a vascular pt eval done on you. i told him that's what he should do from now on before walkers and all equipment for all his patients with POTS.

i also told him i wanted to start a support group as i used to run then for families with children with diabetic children. i said even though today i my not know the date, or be confused because of the side effects of the new meds I want to do this for 1 hour a week some how. he was going to ask the hospital about starting one. YES! Now if it could be on a day i'm there any ways, that would be another blessing.

blessings and love,

bellaMia

[janiedelite]

i also told him i wanted to start a support group as i used to run then for families with children with diabetic children.

That's awesome! I'd love to participate in a local support group too, but haven't found one yet.

[Sunfish]

if you're going to get anything "above and beyond" a standard chair - something that is definitely a good move for anyone who will be using a chair on a regular basis over a long period of time - the advice to get a PT eval for the chair is definitely spot on, though it doesn't always have to come from a "separate" PT source so to speak, as top-notch wheelchair distributors often have their own PTs on staff which - for most folks - can do a great job and - quite often - a better job than many other PTs. bottom line being that - wherever s/he is located - the PT needs to be one who is actually VERY well-versed re: wheelchairs....not just generally speaking but specific to the type that you need to be looking at & purchasing.

i actually have writing a LOT about the wheelchair choosing/ buying/ fitting/ etc. process in recent posts so will try to find them & link them here.

one impt item is that there is a HUGE difference between a lightweight chair & an ultralightweight.

also the "info" you rec'd from the lady re: "how medicare works" is simply NOT accurate re: wheelchairs, standard chairs, etc. it very well may be true where she works but it is not true across the board. b/c if & when an individual's health situation dictates a higher level chair )according to medicare guidelines of course) - whether a power chair, an ultralightweight or lightweight, one that reclines, &/or any or all other numerous options & features - medicare WILL in fact pay. and it's certainly not after any sort of year waiting period with a standard chair. there are of course some situations wherein that is the procedure but it is not "all" or "most".

along the lines of misinformation, if/when you are going to be pursuing any chair other than a standard PLEASE take the extra time & effort to find a distributor more specialized than the one you have been dealing with thus far. i cannot stress to you enough how important this is in SOOOO many realms. for any more specialized chair you should work with a distributor who specializes primarily - if not exclusively - in wheelchairs.....rather than working with a durable medical dealer who has everything from shower stools to compression garments to hospital beds to wheelchairs to ......you get the picture. insurance - medicare/ medicaid/ otherwise - should not be a limitation in this regard b/c they too value the more specialized (and thus knowledgable) dealer (not to mention that in some situations no one other than the more specialized distributors are able to work with a patient/ client) ; bottom line being that there will always be a "wheelchair only"(or close to it, i.e. mobility device-only) distributor in or near your area or - at the very least - one that serves your area via a bit of a commute (theirs, not yours; they will send a rep to meet you at no extra cost.)

hope this helps. i'll look for the other posts/ links and post them if/ when i find them. and sorry for all the run around you've had.

hang in there,

melissa

p.s. my ultralightweight chair isn't purple but is a sparkly deep blue that does have a bit of a deep violet undertone; the blue of my reclining (& leg elevating) power chair has a bit of a deep violet undertone as well

[tinkerbella]

THANK YOU Melissa,

I can't thank you enough for for info and time in helping me. I'll have to forward all this info to my doctor so I'll know for the rest of his Posts pts. as they are getting more patients in our area locally. This is my cardio. He loves any new info I find to help his patients and he directed me here to start with.

Blessings and Love,

BellaMia~