How to get MEDICARE to pay for a power scooter or power wheelchair

#Medicare #fallprevention #physicaltherapy #physiotherapy #occupationaltherapy
In this video a Doctor of Physical Therapy (me) talks about all of the steps required in order to get Medicare to fully cover a power scooter or power wheelchair and how long the process may take.
Medical Disclaimer
All information, content, and material of this video is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.
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[@crazies2816]

I am an amputee of the right leg below the knee with diabetes, kidney disease, high bp, gastroperis, and can only walk very short distances before I am in extreme pain and cant breathe. Thats using a prosthetic limb, a cain, and/or a walker. A wheelchair is useless for the above reasons, and my wife cant push me around. I am 47 and when I go into a medical store to look for a scooter, the first thing the salesperson says is "No way medicaid will cover this for you" and proceed to completely shut me off because we are financially poor. I HATE the "health insurance" in our country and how they just throw people like me to the curb, hoping that I will just go away and DIE!! I AM SO DISGUSTED, I AM ONLY 47 AND THEY EXPECT ME TO BE A PRISONER IN MY HOME! THEY ARE NOT HUMAN, AND I CANT BELIEVE HOW AMERICA ALLOWS THIS!!

[@parkinsonsdiseaseeducation]

Everett my heart goes out to you in this situation. The first problem I see is going to a medical equipment store. Often these don’t accept insurance of any kind. There shouldn’t be a reason Medicaid wouldn’t cover a power wheelchair or scooter for you. I highly suggest you look into NuMotion. They can come to you at home and they bill Medicaid. I’m not sure what state you’re in, but they have locations across the USA. www.numotion.com

[@peterburrows9227]

Ok

[@clintonpowell1443]

My PCP got me one. Now I have to get concrete work done. My total cost was $180. Turnaround time took about 6months.

[@parkinsonsdiseaseeducation]

I'm glad you were able to get one! Good reminder that turnaround can be longer. 2-4 months is typical, but at times even longer with the shipping delays we are seeing now.

[@cynthiasatterfield8333]

I'm 71 and I have arthritis in almost all my major joints, neck and upper and lower back. Both my shoulders and my right knee are bone on bone with bone spurs and my left shoulder has bone forming in the muscle. The cartilage is deteriorating in my right hip and right ankle. Wait for it. I'm not done! LOL! I also have/had Carpal Tunnel Syndrome in both wrists. I have had Carpal Tunnel Reduction surgery in my right wrist and my left wrist is rated at moderate to severe. My left knee was bone on bone but it's now titanium and plastic but is not, and probably will never be, 100%. Because I have a heart condition and asthma there'll be no further surgeries unless it's life threatening. So, I talked to my PCP (sometimes I think she is on that) about getting a motorized wheel chair small enough to fit through narrow doors and portable enough to fit in the trunk of a car. Before I left their clinic a nurse comes in and tells me I have to talk to my insurance company first because there are so many different kinds she doesn't know which one I would need and if my insurance company would pay for it. I have a Medicare Advantage insurance plan, by the way. So I called my insurance company and was told that I needed to have my PCP contact them and wouldn't discuss anything more than that they do cover foldable, motorized wheelchairs. After waiting as long as 42 minutes on the phone and no phone call returned when I asked them to have someone call me back and they didn't, TWICE, I threw my hands up in despair! My son took out a loan and ordered your Electra 7 HD Wide chair. One of the selling points is where the batteries are located. I'm not able to kneel or reach under to deal with batteries. Yours being located in the frame allows me additional independence. He's just received it but hasn't put all the accessories on it yet. I was absolutely delighted to find your company and this chair in particular. I am super excited to get it here, to my home, set up and ready to go! I searched the internet to find your company and this specific chair. It is perfect for what I need! I'm looking forward to a pain tolerable mobility for the rest of my life!

[@parkinsonsdiseaseeducation]

Hi Cyndy. I’m so glad you are getting a chair that will fit your needs. I’m not sure what you mean by “your chair” and buying it from “your company.” My physical therapy practice does not sell equipment. Sounds like you mean the company that manufactures the chair.

[@charliehorse43]

I am Veteran and a patient at a VA Hospital. I think the medical evaluations are the same but how they look at more then just using it in the home. They paid for a ramp for the house I live in which I understand Medicare Medicaid does not do. If you are a Veteran but not using the VA you should them and what can do help you.

[@parkinsonsdiseaseeducation]

Charlie you bring up a wonderful point. You are correct that Medicare and Medicaid do NOT pay for home mods such as ramps, bathroom access, etc. I agree that you should use these VA benefits when and wherever you can. Sadly, I feel like there are some Vets who don’t see themselves as worthy of using the VA system for various reasons.

[@iamnothere6513]

My experience with Medicare is that what they are willing to pay for is the smallest, cheapest, and absolutely least usable mobility device on the market.

[@parkinsonsdiseaseeducation]

In my experience it depends on how well the case was documented and if the ATP recommended the right equipment when teaming up with the therapist. But honestly, Medicare doesn’t always cover everything at 100% even in the best case scenario. I’ve seen Medicare cover chairs with tilt-in space seats, elevating seat, with joystick, elbow rest, posture guides, etc and the patient had no out of pocket OR at the very least they only owed 20% if they didn’t have a supplemental insurance policy

[@MonicaMariaMcLean]

And I know why I can't know Walker wont-work. Because I can't walk and I can't stand up. So that's out of the question.

[@Price-Williams]

Real simple, join, . United Health Care, i just got my Pride MED Power Chair, 2. Acid Sealed, Silica Type A 12 volt Acid sealed batteries, don't last long, not 5 miles, in flat land mobile Alabama, mat be with Lithium Ion Batteries.

[@letanyabaucom951]

Thank you for the update cause that's where I'm getting ready to go do in March and I go to the doctor I'm get quanto edge. Yeah i'm hoping that I can get it

[@theamazingbiff]

I'm about a year and a half into Long Covid and waiting for my appointment with a PCP to talk it over. I thought that was all I needed! The more detailed explanation is discouraging (especially the 6-12 months part!) but it's great to be prepared. Thank you.

[@parkinsonsdiseaseeducation]

I sympathize with you on the wait. It’s definitely a process, but at least it will get paid for. Honestly the wait times are more due to supply chain issues at this point, ironically due to COVID

[@ACTIONSPEAKSgjhkc1980]

Power Wheelchairs for Senior Citizens from Simple Manufacturing to Delivery, Although Appropriate Approval Takes 6-12 Months. Why?

[@parkinsonsdiseaseeducation]

I’m not sure why it would take 6-12 months, but I can tell you since the pandemic supply chain issues have plagued the power equipment industry. There have been times in my experience when a part is literally sitting in a ship in a harbor in NYC and they can’t get it for two more weeks or longer. The manufacturing process isn’t always simple when it comes to custom seating and mobility because some power chairs require customized joysticks, posture stays, arm rest lengths, etc

[@ACTIONSPEAKSgjhkc1980]

Power Wheelchairs for Senior Citizens from Simple Manufacturing to Delivery, Although Appropriate Approval Takes 6-12 Months. Why?

[@parkinsonsdiseaseeducation]

Hey Gloria I think this was a duplicate comment. I replied on the other one. :-)

[@patgill59]

Are you talkijng otherelctric wheel chairs besides Hovr arounds?

[@parkinsonsdiseaseeducation]

That’s a great question! Yes, this includes custom fit power wheelchairs of various levels of technology. Medicare at this time does not pay for elevating seat function, but they do typically cover tilt-in-space, certain joysticks, custom posture medications, etc. Medicare will completely replace existing power mobility equipment every 5 years as long as there is still a justification for why they still need the equipment. This coverage that I spoke about also includes power scooters as well. This is typically for those who transfer well and have relatively little issues with sitting balance or posture control.

[@MonicaMariaMcLean]

I know I'll push wheelchair will not work for me. Because because I cannot push for a long. of time. And then I get blisters all Uber my on my hands frompletion a wheelchair that's not a lecture that's my having a push chair is not gonna work for me.

[@parkinsonsdiseaseeducation]

Hey Monica. Based on what you described in your comments you would likely qualify for a power wheel chair or scooter without an issue.

[@Karelife]

I really need to get a power over a manual because of carpal tunnel syndrome in both wrists and not a lot of upper strength. Is that a good reason to get an power chair?

[@parkinsonsdiseaseeducation]

💯 percent. The CPS combined with the upper body weakness would prevent you from being able to effectively use the manual wheelchair and therefore the PT or OT that evaluates you should be able to make a good case for power over manual

[@Karelife]

@@parkinsonsdiseaseeducation thank you so much. Now I can move forward with the whole process. Relief less worry and stress.

[@parkinsonsdiseaseeducation]

Glad to help.

[@dillanlewis276]

So I had a brain stem stroke and I use a walker and am constantly struggling to balance when I walk it has been 3 years now I moved to another state I had some kind of nurse as my pcp but she no longer works there I am only 28 do u think I'm eligible

[@parkinsonsdiseaseeducation]

Dillan you could very well be eligible depending on your coverage. If you have disability with Traditional Medicare or even Medicare advantage this would cover your equipment or at least a significant portion of the cost. In most cases state Medicaid should cover as well. As long as you are under the care of a physician who has seen you face to face 45 days prior to or following your assessment for a PWC you should be ok

[@Rob-ur4ft]

Save the money and buy what you want. You can get a good scooter for $1,000.

[@parkinsonsdiseaseeducation]

@@Rob-ur4ft this I take some exception to. Why would one pay $1,000 for a scooter that isn't custom fit for individual needs when Traditional Medicare and many other plans will cover all or majority of the cost and it can be completely fit for the individual? A $1,000 scooter may not be appropriate for everybody. In fact many people can't safely use a scooter and need a power wheel chair instead.

[@Rob-ur4ft]

That guy wasted the first 2 to 4 minutes stuttering about what to do. I listened to his "story" just to see if he said anything intelligent. He didn't.

[@parkinsonsdiseaseeducation]

Thanks for your comment. Perfection isn't what gets people the help that they need.

[@abdihassan2966]

You very mean guy. The guy w takes off from his busy schedule and educates the public. Let the rest of us benefit from his commentary if you have the information or expertise.

[@parkinsonsdiseaseeducation]

Thank you for your kind comment 🙏

[@whatnowok]

Parkinson’s don’t listen to mean people here

[@parkinsonsdiseaseeducation]

Nah, I don’t have time for mean people. :-)

[@Rob-ur4ft]

This guy is a Doctor? He needs HELP!!!!

[@parkinsonsdiseaseeducation]

I'm a Doctor of Physical Therapy not a Doctor of public speaking. I'm not offended that you aren't impressed.

[@abdihassan2966]

Goofy rude individual.

[@beverlyphysio4359]

You need help not him; you need to check with your Doc buddy!

[@parkinsonsdiseaseeducation]

Thanks for the support Beverly. This isn’t my best video but ironically it’s one of my best performing videos which tells me it’s information people are looking for

[@utubewatcher3852]

I could use one I had a stroke in February can't walk I have no income just foodstamps and on medical in California

[@parkinsonsdiseaseeducation]

That’s a tough situation, I’m sorry to hear that you are not able to walk. You should be able to find a provider that accepts MediCal to do the therapy evaluation. For a DME company I’d look into NuMotion. This link will take you to their CA coverage map. I have worked with them locally in OK and they do a fantastic job. www.numotion.com/Numotion/media/CoverageMaps/CA-County-Coverage-Map-110218.pdf

[@tomtran270]

Show me how to.get asap

[@parkinsonsdiseaseeducation]

Are you in the United States of America?