Survival Guide for
Wheelchair procurement (whether buying
privately or qualifying for coverage under Medicare or private insurance)
is a lengthy and sometimes confusing process. It usually takes
several months, even as long as a year. Keep the following
tips in mind as you begin this challenging process.
The most important thing you can do
is keep a journal! Write down every person’s
name that you speak to, the company or organization (i.e.
doctor’s office, supplier, insurance agent), date, and
what you were told.
- Being able to name the person you spoke
to and what was said gives you credibility
- If someone promises you a special price,
recommends a particular chair or function, or if the doctor
gives you advice, you need to keep a record to refer to
- Writing thorough notes also lets you
keep track of calls and tasks
Your wheelchair may be delayed for any number of reasons:
the prescription is missing information, there’s a delay
in scheduling a meeting with the seating therapist or supplier,
or the insurance company requires more information, like a
letter of medical necessity, or there can be a hold-up by
the manufacturer. Expect delays, but don’t lose your
cool. Instead, be proactive!
Never let your case fall through the cracks.
Stay informed about the status of your wheelchair by calling
the appropriate member of your mobility team, as needed. Write
down the results of all communications (phone calls, written
notices, etc.) Your mobility
team is: you, your doctor, seating specialist, supplier, and insurer.
Stay on everyone’s radar screen by following each phase
of the process. Make sure each team mate does his/her part
(mails prescription, calls the manufacturer, talks with insurer,
etc.). You are the Project Manager!
If there’s a problem with insurance,
ask your doctor or seating professional to write a letter
of medical necessity, then make sure the letter gets sent
out and received by the insurer. Don’t be afraid to
keep calling until all problems are resolved. You will get
a wheelchair, unless your doctor thinks another type of mobility
device is better for you. You may not be the only person who
needs one, but your mobility is vitally important!
Denial by an insurance company is common, even typical. If
you are denied for a wheelchair, don’t be alarmed. First
find out the reason for the denial, then ask your doctor or
seating professional to advise you on next steps. Your insurer
or Medicare may only want further clarification.
If appropriate, your doctor will write an
appeal letter to insurance for you. Give him or her a couple
of weeks to prepare and send it Then call the doctor’s
office to make sure it was mailed and/or faxed and the date.
You should get a copy mailed to your home. If you don’t
get a copy, ask your doctor’s office to send you one.
Sometimes the doctor asks the seating specialist
to write a letter of medical necessity, and then
signs off on it. That is because the details of your case
are very detailed and must be adequately explained in writing.
Since a seating specialist (a physical therapist who specializes
in wheelchair seating and positioning) makes and writes up
an assessment for you anyway, it’s easier and typical
protocol for the specialist to write appeal letters.
Follow the paper trail, stay on top of it,
and make sure it’s sent out. After a couple more weeks,
call the insurance company and ask if a new determination
was made, based on the appeal letter. Hopefully, your wheelchair
will soon be approved for coverage. (You may also have to
make a co-payment or satisfy a deductible.)
Sometimes patients have to appeal several times. Don’t
waste time worrying about it; just follow through on each
and every step, until your chair is approved.
The process is slow and frustrating
and that’s unfortunate because most people can’t
afford to wait. But there is fraud in the marketplace, as
well as mistakes in seating, so insurance must be satisfied
that you are receiving the appropriate equipment. In the long
run, this benefits all consumers. Try not to get discouraged
and take a break when you need one. Make those phone calls
in a day or two, when you’re alert and refreshed. All
your work pays off when your new wheelchair arrives!