Beginning to end, the wheelchair fitting experience: how to be effective, efficient and empowering

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:
1. Referral
2. Evaluation
3. Follow up appointments (as necessary)
4. Home Trial (depending on equipment)
5. Face-to-Face
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.

Here is a typical timeline for getting a wheelchair.

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.

Why should we care about dynamic seating with wheelchairs?

I sit still all the time. Hopefully you can see the sarcasm as I write this. My parents have told me from the time I was born, I have moved constantly. When we seat our patients in wheelchairs it is imperative to know that our patients move. Just because one is in a wheelchair and their ambulation is compromised does not mean movement comes to an end.

What is this? A suspension for a manual tilt-in-space wheelchair. These can be added to help make the patient’s ride in their chair more comfortable. Especially helpful going over thresholds. Unfortunately not normally covered by insurances but well worth the $399 to have the pair installed.

Think as you read this blog how many times you move. So what does this mean for wheelchair users whether they are a 8-year-old CP patient or a 85-year-old dementia patient? They want to move in their chair just as much as you do. The average person moves every 20-30 seconds shifting in their seat, moving their arms, etc.

Some of the items I never considered dynamic (i.e. which means movement) would be air bladders on cushions (i.e. A Roho cushion) or even stretchable shoulder harnesses. These are nice because even though the patient may be in a wheelchair, it allows for movement.

At Howard’s I have a handful of patients who have broken footrests because they push on them throughout the day. There are dynamic wheelchair footrests on the market that actually extend and then retract with a spring allowing the wheelchair user to fidget in their chair.

One of my favorite items we learned about is someone has finally made a suspension system for tilt-in-space wheelchairs. No one in their right mind would ever drive a car without suspension. Today’s mountain bikes have a suspension system. Wheelchair users complain that going over thresholds can cause them pain. We can now install a suspension system to let your loved one to help with “impact dampening.” I put the words “impact dampening” in parentheses because if we ever were to have them covered by insurance this is how it has to be phrased because insurance do not count comfort.

Dynamic Footrests move when you press against them. What you see here is one footrest (on the left) that has a spring in it and moves out. The other footrest (on the right) goes out and articulates up too.

If you have questions about dynamic seating, give us a call at Howard’s and talk to one of our two ATP’s on staff.

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.