Category Archives: For Patients

Building Block Nebulizers!

Lego Neb by AirialDo you hate trying to get your kids to eat their vegetables? I can only imagine in my family how much easier and more enjoyable dinner time would be if we did not have to go through this ordeal every night. Imagine if you have a young one who has asthma and has daily treatments with a nebulizer? I have good news and its . . . AWESOME!

Howard’s just received our first shipments of block nebulizers that kids can play with. We had a child in our store yesterday and he was excited for his asthma treatment because now he gets to play while taking his medication.

In addition to the starter set, we have two other nebulizer packs (one with pirates) and the pricing starts at $14.99 so if you are a mom or dad and have a little one who needs their nebulizer, go with the FUN way and try our new nebulizers. Also, if you are older, we won’t judge, you can get one too if you’d like!Pirate Series Neb

Last, nebulizers are covered under all insurance programs if you have a valid prescription and diagnosis.

Call us if you have any questions, we are here to help!

Erik at Howard’s


City Series Lego

Preparing for surgery

Preparing for surgery can be full of anxiety. About of the quarter of the patients we work with at Howard’s are surgery patients. Hip replacement, knee replacement, back surgery, etc.  Most of these surgeries are predicable where the patient has had some kind of chronic problem and then after all other forms of therapy, drugs, and alternate forms have failed the patient decides to jump in and get cut.

We have some amazing doctors in Yakima or Seattle depending on where your surgery takes place so know you are in good hands. When the surgery is done though, there will be a period of recovery that varies in time depending on your surgery.

I went through back surgery last year and it was hard for me to realize I would be sidelined for a period of time given I had backpacked 18 miles over hilly terrain a few months earlier. I thought I would rebound quickly. However, when you are cut in surgery, there is a set amount of time the body must recover and no matter how fit or unfit you are going into surgery it is going to take a few weeks to months to recover.

After you get out of surgery you will have a team of nurses that tend to your every need. But once you go home, unfortunately the nurses do not go home with you. So what are you to do?

This is where Howard’s comes into play.  We have multiple items designed to make you or your loved one’s life easier as they recover from their surgery:

  1. The lift chair—For a patient that has either hip or heart surgery these are a must in our opinion until strength comes back. At Howard’s we rent them for $75/week or $150/month. Delivery, setup, and removal are included in the price.  Even if you are strong, the lift chair will recline and lift you up at the push of a button.  They are even very comfortable and allow for sleep if you would like.
  2. Hip kit (this is pictured on this page)—If you have had back, hip, or heart surgery you may lack the strength for several weeks you had pre-surgery. The hip kit (pictured) comes with a reacher, extra-long shoehorn, elastic shoelaces, long sponge for the shower or tub, and stocking donner to help you put your socks or compression hose on. The complete kit runs $49.99 or you may by each individual item separately at Howard’s too.
  3. Bedside table—You may be spending a lot of time if your favorite chair or couch, you will want to eat and read frequently from this location. The bedside table is very helpful as it is on wheels and has a height adjustable feature to it.  We rent them for $15/week or $30/month.
  4. CPM—A Continuous Passive Motion machine is needed for anyone who has knee surgery to keep the joint moving. Usually insurances will cover these items for 21-days post-surgery.  Howard’s has a complete inventory of CPM machines so make sure you have a prescription
    The hip kit from Howard's comes with everything you will need to recover from hip surgery.
    The hip kit from Howard’s comes with everything you will need to recover from hip surgery.

    and pick it up at least two days before your surgery.


  • For our rental fleet of lift chairs, we only use Crypton fabric from Pride Mobility. This fabric is waterproof and allows for disinfecting after each patient.  Because it is a fabric, it is still comfortable and not uncomfortable like the old vinyl lift chair of the past.

As always, if you have any questions or need home healthcare supplies give us a call at 509-654-9899 and let our family serve your family’s healthcare needs.


Benefits of a HSA

We waste a lot of time at Howard’s! Not really if you look at it from a business perspective; however, the average oxygen patient for us to get their paperwork covered by Medicare requires eight faxes and two trips to the doctor’s office. A complex rehab wheelchair runs around ten faxes, three trips to different provider’s offices, and a final patient file that usually is over forty pages long. Even something as simple as a basic brace comes with a prescription and at least five pages of documentation and intake forms.

Why not use a HSA account instead?

The HSA or health savings account in my opinion could solve our country’s health insurance problem. For those that do not know what a HSA account is, it is a tax advantaged savings account for people who are enrolled in high-deductible insurance plans.

From a personal family standpoint, I decide how to spend our family’s money.  Instead of being limited on what our insurance covers, we can use it on what our family feels serves our health needs best. There are requirements to things you can and cannot spend the money on.  For example, a health club membership would not count.  But items our family has used the money on: chiropractic care, massages, drug prescriptions, copays at our doctor’s offices for check-ups and test, etc. are covered under a HAS plan and tax-free (in 2015 $3350 for individuals and $6650 for families).

Now if it were up to me, I would give a cash discount to anyone who wanted to buy at Howard’s because this would make a lot of sense because it would allow us to focus on taking care of the customer instead of chasing chart notes and paperwork. Unfortunately, Medicare does not want us to do this because there is actually a law that states we need to give the same price to Medicare as everyone else.  So what have we done at Howard’s? We have two lines of braces and products: one for our insurance patients made by a specific brand; we also have another brand (non-coded for you high-compliance lawyers out there) that we have specifically for our HSA patients or cash pay patients.

For example, our carpel tunnel wrist brace through Medicare and insurances we charge about $79.99*. A very similar brace from our similar vendor for our HAS or cash pay customers runs between $19.99 to $29.99. See the difference in price?  Likewise our insurance scooter (coded at K0008 for our lawyers) runs $1499.99.  A very similar scooter (coded E1399 which is a misc. non-covered code by Pride Mobility our scooter provider) sells at $999.00.

Now there are usually two people out there who come into the store who figure out what we are trying to do at Howard’s. The first group applauds what we are trying to do. The second group will frequently get mad at us for circumventing the rules of Medicare.  However for this second group who wants us to give Medicare the same pricing, I want to remind this is the same Medicare who requires us to use costly methods of paperwork, faxing, visiting doctor’s offices, etc. to meet their documentation requirements.

In summary, know that if you are paying for an item with cash or a HSA account you can get a nice discount if you buy specific items.  If you are a patient who has Medicare or Medicaid (DSHS in the state of Washington) please be patient with us because your insurance has us jump through a lot of hoops before we are paid.

Erik Mickelson—Team Lead and ATP at Howard’s Medical

*Now on these prices that we charge, most insurances including Medicare have something called an “allowable” which is what we are actually paid on the item.  At Howard’s we comply with these allowables.  For carpel tunnel wrist braces they run between $45-70 and if you have a copay, your copay would be off of the allowable amount and not the charged amount.  We work and bill with over 100 insurances so this means over 100 different allowables. I leave this up to our incredible billing team!

Yakima’s air

If you have to have a nebulizer treatment, might as well have a cool looking fish or dog!
If you have to have a nebulizer treatment, might as well have a cool looking fish or dog!

Winter and springtime can be a really difficult time for people with respiratory problems in the Yakima Valley as the air goes from stagnation to being filled with pollen.  At Howard’s Medical, we come alongside doctors by offering home oximetry testing which tests one’s oxygen saturation level as well as heart rate which is a great respiratory screening tool.

It is mid-February and my family has each already had the flu.  Our doctor in Selah told us that the flu is pretty much epidemic in the valley right now unfortunately.

So what does this mean? If you unfortunately need a home nebulizer, you can pick these up at either or Selah or Yakima store.  If you can’t come, give us a call at 654-9899 and we offer deliveries anywhere in the Yakima Valley.

If your doctor does order an oximetry test, we have to have a valid prescription on file for this.  These tests are a wonderful diagnostic tool and really helps him/her figure out how much of a respiratory problem one person may have.

Last, we also offer home and portable nebulizer units which dispense prescription medication.  For super active patients, a portable nebulizer if great because a child with asthma can get a treatment before soccer practice in the car as an example. For other young kids, we have kid-centric nebulizer units like a doggie-neb.

Which walker is right for you?

When it comes to walkers and canes I have to admit that I’m a nerd. I have been known to stop people at Costco and church and refit their ill ‘fitting walkers and canes they have  purchased on the internet or at another medical supply. When it comes to fitting a walker, the key thing to remember is the handgrips need to at the level of the hip joint. If it is too high, it can get away from the customer. If the walker is too low, it promotes bad posture.
One of the most common features one can add to a walker is wheels. In fact, I would say about 95% of our walkers we dispense at Howard’s has wheels because it makes it much easier to propel. If you are not sure whether or not wheels is right, it is best to talk to your doctor or physical/occupational therapist who is familiar with if they are right for the patient’s current mobility situation.

Canes, crutches and walkers are designed to add stability and increased independence. Many people do not know that once someone is at a high risk of falls and lacks the coordination with a walker with wheels then a walker with wheels SHOULD NOT BE USED! At this point, it is strongly recommend the patient move to a wheelchair because of the level of risk.

Unfortunately, I can tell you several stories of people who were fine with walkers but only switched to a wheelchair after a fall instead of before the fall. If you or a loved one is becoming unstable, don’t wait until after the fall where a hip has been broken.
One does not need a prescription to get a walker at Howard’s; however, if they would like us to bill their insurance for a walker, we have to have one ahead of time and most insurance will cover walkers as long as they have not previously purchased one in the previous five years or previously purchased a wheelchair, scooter, or power wheelchair.
With the advent of the internet I have to admit that someone can purchase a walker cheaper on sites such as amazon or other online medical supply stores. One of the benefits of shopping at your local Selah or Yakima DME (durable medical equipment) store such Howard’s is we will offer the proper instruction on the use of the item. We usually also offer a 15-day trial (if the item is brought back in new condition). We also offer a one-year warranty if something needs to be fixed or brakes tightened that first year.

Walkers range in price from $59.99 from your standard grade aluminum folding walker up to $399.99 for a European walker with suspension system. We also have a whole lot in between with big wheels, small wheels, new, used, pink, green, blue . . . you get the point?
The picture with this blog is the rolling rollator with 8” wheels with seat, brakes and basket. It retails for $179.99 but is usually covered by your insurance.

If you have any question regarding walkers, give us a call at 509-654-9899. As Forrest Gump’s friend “Bubba” knew of hundreds of different way to prepare shrimp, we at Howard’s have almost a hundred different kinds of walkers to sell or rent (this is an exaggeration but it is still about ten different kinds in our store and including drop-ship options and colors is over one-hundred).

Walk upright, Erik (team lead Howard’s)

Medicare Wheelchair Coverage

I would like to go deeper into the explanation of what Medicare covers regarding wheelchairs.  There are two popular types of chairs used for daily activity of more than two-hours/day.  These would be what I call my full-time patients who have MS, had a stroke, dementia, etc.:

K0004—high strength, lightweight (I recommend the Insignia from Invacare or Stylus from Pride and is 33 pounds). Medicare pays for this at $142/month (if no co-insurance, only $113).  If we were to go this route, Howard’s accepts what Medicare pays and the patient would only have an out-of-pocket expense if Medicare didn’t pay because of lack of doctor documentation or if the patient had a copay.

K0005—ultra-lightweight wheelchair (this is the Prospin 4 I recommend from Invacare or Lifestream from Pride, base weight of 15-17 pounds, actual weight of about 27 pounds). Medicare typically does not cover these chairs but you do have the option of using your K0004 credit toward these chairs if you would like to upgrade.  Think of car shopping and if you decide to get power windows and locks or a sunroof, it is a upcharge. For example, if you buy the chair for $2200, over the next 13 months you would be reimbursed $142/month from Medicare which is what you would have received had the patient received a K0004 wheelchair so the actual price on the wheelchair is closer to about $400-600.  Howard’s expects the patient to pay the full amount up-front (in Medicare terminology this is called non-assignment).  Last, some people do not like the risk because if the patient goes to the hospital, nursing home, or if the doctor does not get back the right paperwork to Medicare, Medicare does not pay the full amount of the wheelchair.

Accessories—No matter what direction you decide to go on a wheelchair, I usually recommend billing accessories to Medicare.  You just need a standard prescription for these and they will pay for them minus the 20% copay if the patient doesn’t have co-insurance. I personally are bugged to see certain people sit in wheelchairs without a standard cushion and anti-tippers.  One is for comfort, the second is for safety for going over thresholds and up ramps

As always, let me know if you have any questions.  Howard’s offers free quotes and in-home evaluations.  Many people can’t track with this discussion but a lot of other people really enjoy getting technical understanding the ins/outs of insurance rules and regulations.

Regards, Erik Mickelson ATP

Assistive Technology Professional

Manager of Howard’s Medical LLC

How to fit a CPAP mask

The CPAP machine is a necessary tool in helping patients with sleep apnea. Unfortunately for some of these patients,  they are constantly fighting with their cpap mask. Just as there is not one pair of shoes for you, we have over 30 different kinds of masks and headgears for our patients. Everyone has a slightly different sized face and head. If you are having problems with your mask, bring your mask and machine into one of our two stores and we will professionally fit you. Call us at 654-9899 for an appointment.

The advances in CPAP masks

With the modern advances in CPAP machines come great customization. Our new headgear options allow patients to customize and personalize their therapy systems to reflect their lifestyle and personality. We have a colorful arrangement in headgear: pink, light blue, and camouflage. For our women, we have a brand new silicone headgear that goes around the ears so you never have to worry about getting your hair tangled in your headgear again.

Stop by one of our two locations in Selah next to Red Apple or Yakima on north 16th Ave.

The Importance of Mild Exercising

I often tell my patients who come into Howard’s for diabetic shoes about the importance of mild exercising with an off-handed joke, “if you don’t exercise, you will be in here getting a wheelchair from me eventually.” With our muscles, the term, “use it or lose it” is true. First, if you have not exercised in a while, talk to your doctor before starting any healthcare program, particularly if you have had any health problems. If you have mobility limitation, this does not mean you can no longer exercise. At Howard’s we have an item called the “Peddler” which allows someone to exercise their legs or arms from a seated position. Next we have therapeutic support bands and balls to help exercise portions of the body you might be rehabbing from surgery. Last, we also have found that by having someone ambulate with a cane or walker allows them to do more exercising. After you talk to your doctor, come see our mobility aides we have at Howard’s Medical.

A peddler is a great start to your mild exercise program:

Hospice Explained

Continuing our helpful tips relating to your medical supply needs. Just click the play button below…

      1. Hospice Explained