Why is it so hard to get a wheelchair covered by insurance? The short answer is most insurances don’t want to give them out if they are not medically necessary. We can go round and round philosophically about this and a lot of people today are just saying, “I will pay for it with cash so I don’t have to hit the appointments.”
For those wanting to get a wheelchair covered by insurance, it takes three to tango and if all three are not bought in, the wheelchair can’t succeed. So who are the three and what is their role?
1. Patient–In wheelchair seating it starts with the patient. He/She must attend all scheduled appointments, participate in the trial of equipment if it is unsure whether they can use it, understand the realistic timeline for obtaining the equipment, communicate with the team (about demographics, trial results, equipment fittings, etc.), demonstrate the safe use of the mobility equipment and attend follow up training/fittings (as appropriate). We have had several patients where the they were never bought in and the process never finished. Other times, the patient has gone out of their way, and has been very satisfied with their equipment and their increased mobility.
2. Therapist–Therapist do not have to get involved unless we are working with ultra-lightweight wheelchairs, tilt-in-space, or high-end complex rehab powered mobility; however multiple times they are involved in a standard wheelchair. It is their job to complete a thorough mobility evaluation, provide mobility training (during evaluation and treatment sessions), write the Letter of Medical Necessity including equipment justification, communicate with the team, write addendum (s) to the Letter of Medical Necessity (as appropriate), direct follow up mobility training sessions (as appropriate), and pressure map current and/or new equipment (Howard’s realizes that not all PT/OT’s do not have this equipment which is why we offer this service and have our own pressure mapper). We have found that not all PT/OT’s have the time to do all that is required for all wheelchairs. Ask your therapist if they are willing to do this. If not, we have a list of all therapists in the Yakima Valley who are willing to do mobility and wheelchair evaluations and would be willing to let you know who they are.
3. Vendor–The vendor has an important job as we have to not only provide the equipment but also have to bill it. It is our job to also attend requested appointments, complete home trial form (fax or electronic)*, provide updates to the team: additional documentation needed, insurance approval/denial/pend, delivery date of approved equipment, communicate with the team, attend follow up training/fitting sessions (as appropriate), pressure map current and/or new equipment as indicated, and help with the maintenance and warranty of the equipment. We have a team of five in the rehab department of Howard’s so this really helps as we are orchestrating talking with everyone involved. At Howard’s we have Dawnie who answers most of our rehab calls and coordinates the process. Aleah leads our team and verifies all paperwork and usually is the one submitting it to insurances as well as orders the equipment. Erik and Daryl are the ATP’s. And we have multiple Operations Technicians who help in certain deliveries and warranty work.
The reason why so many get frustrated in the mobility process is if ONE of these requirements is missed, it can prevent a wheelchair from being dispensed and paid for by the insurance.
In summary these are the hoops one has to go through:
3. Follow up appointments (as necessary)
4. Home Trial (depending on equipment)
6. Paperwork to insurance
7. Equipment approved
8. Equipment delivered
9. Follow up appointments (as needed)
We know, the process is hard but this is the dance we have to play. Give us a call at 654-9899 and the team at Howard’s would love to work with you and your family in this process.
Erik Mickelson Erik is the CEO and ATP of Howard’s Medical a local durable medical equipment supplier in Yakima, Washington that has four locations in Ellensburg, Selah, Yakima and Sunnyside in Central Washington. I will be blogging this week from the ISS (International Seating Symposium) in Nashville, Tennessee. Most of this process in this blog comes from N. LaBerg and the wheelchair clinic in Minnesota.