Category Archives: Mobility

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.

Getting your wheelchair covered by Medicare

Working in DME (durable medical equipment) and getting items covered by insurances is a lot like purposely asking for 1,000 paper cuts. There is no degree that prepares one for medical supplies (I have a bachelors from the University of Washington in English with a minor in History).

We struggled for years fighting with doctors, patients and especially Medicare getting the necessary paperwork to get one’s wheelchair covered by insurance.  Even when you think you have everything, process the claim and get it paid, Medicare will come back with post-payment audits and can take their money back! What I learned in getting my college degree though is nothing is more valuable than doing your own first-person research on an individual area of study.

The Breezy Ultra 4 is our standard high-strength lightweight wheelchair we are currently using at Howards.
The Breezy Ultra 4 is our standard high-strength lightweight wheelchair we are currently using at Howards.

We have been in business now going on our second decade at Howard’s and we are very optimistic given the difficult environment CMS (i.e. Medicare) has us follow.  Some of the things Howard’s does to get our wheelchairs covered is we have a staff of four full-time team members devoted just to wheelchairs.  We have a team member (Alyssa) who is in our retail store daily to take all phone calls. We have two ATP’s (Daryl and myself) who do all fittings and build wheelchairs. Last, we have Aleah (my wife) who masters the LCD (local coverage determination or in Medicare’s words: their pages and pages of requirements for an individual item to be covered).

Unfortunately this is not the most efficient way of getting equipment into our patient’s hands.  A lot of time I dream of saving our government money but in life we have to play by the rules that our government gives us.

If you or one of your family members needs a wheelchair, give Howard’s a call 654-9899 and ask for a member in our wheelchair/rehab department.  We pride ourselves on staying up-to-date on the latest technology as well as the requirements for the equipment you need and deserve.

Erik Mickelson—ATP Howard’s Medical

The addition of The Serta®’s perfect lift chair to Howard’s

We are excited to announce the addition of The Serta®’s perfect lift chair to Howard’s. It has unique features such as Serta®’s premium cool action memory foam, a softer seating surface, individually wrapped coil springs for a balanced seating experience as well as Pirelli® web backing that contours to the individual user’s back.

One the things that Pride did to make the chair more comfortable is add the gel to both the seat and arms of the lift chair. What this gel does is the moment you sit down, it contours to your body reducing pressure points that a typical user in a normal chair may experience.

This chair is designed for multiple customers but the two that have enjoyed it the most are our lift chair customers who spend numerous hours per day in their chair, especially those that nap in the chair on a consistent basis. The second kind of customer who loves this chair is the customer who appreciates higher end items.  We carry both good, better and the best kinds of lift chairs in our store and the Serta® chair would fall under the best category.  Pride has not spared expence in crafting the back, seat, and arms of the chair.

The Serta®’s perfect lift chair is so comfortable; you’ll feel the difference the moment you sit down.  Try out the Serta difference at our Yakima showroom on north 16thave. any week-day until 6pm and Saturdays until 3pm.


Walkers, walkers and more walkers

In the sound of Bubba from Forrest Gump, “We’ve got pink walkers, zebra striped walkers, titanium walkers, four-wheeled walkers, two-wheeled folding walkers, walkers with seats, orange walkers, green walkers, black walkers, big-wheeled walkers, European walkers, bariatric walkers, small-wheeled walkers, junior walkers, walkers with deluxe seats, super-sturdy U-step walkers, walkers with cup holders, walkers that turn into wheelchairs and at least ten more.”

One of the funniest lines in the movie from Forrest Gump is when Bubba talks about all of the different ways you can prepare shrimp. I find myself thinking in this tone of voice when I look at all the walkers in our store. If you think of it though, if you want to get a walker, you don’t want some general  walker, you want the walker that is built for you and your own needs.  Insurance companies would love for everyone to have the generic aluminum folding walker because they are cheap and affordable.

Don’t get me wrong, the general run-of-the-mill aluminum folding walker is perfect for the patient that has just had a hip transplant and needs to use it for a few weeks until they get back on their feet.  It is also great for those that have a sprained ankle or sore knee and will quickly heal.  However for someone like my grandfather who will be using it the rest of their lives and want to be as mobile as they can be, a walker with large wheels and a seat is the best option for him.

Everyone is different and if you or a loved one needs mobility help to stay active, swing by one of our two locations and we would love to take you through test stroll of all of the walker options out there.

Because we have orange walkers, green walkers, blue walkers . . .

Our mobility team

Not everyone has the luxury of walking and standing all day long.  At Howard’s, we have the largest rehab staff in the valley to help fit, fix, and delivery both manual and powered wheelchairs enabling our patients in their daily living activities. Our team members specialize in the latest insurance requirements and work with physical and occupational therapists as well as your primary physician.

I (Erik) achieved my ATP from Resna three years ago which is the certification one needs to be able to fit what is called group three power wheelchairs according to CMS (Medicare’s standards).  We added a second ATP to our staff (Daryl) this year and also added Aleah to work our documentation team.  In addition to our rehab team we also have our operations staff who fix our existing chairs and can even fabricate special modifications to wheelchairs.

Unfortunately, many wheelchairs are extremely difficult to get covered by insurances.  For some complex cases, we have had over fifty pages of documentation of quotes, chart notes, and therapy evaluations to get chairs covered by insurances.  This is why I am so thankful to have such a talented staff on our team.

Whether you are looking for just a standard wheelchair, a lightweight wheelchair, a bariatric wheelchair, power mobility, tilt-in-space, or a basic motorized scooter, make sure you have a team who will stand behind you ready to take care of you.

 If you or a loved one has mobility needs, give us a call at 654-9899 and let our family serve your family’s healthcare needs.