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Re: group 4 chairs

Postby expresso » 31 Jan 2021, 20:16

going forward - with the new rules changes etc, it would be easier as long as the rest of the Chain - DME insurances are updated with the new rules - it wont be as hard to get group 4 outdoor chairs then

but even so - you will have some insurances who will not agree - and being that we have 100s of insurances we can choose from - in your case Medicare Advantage - turned out to be good and not deny it - but most are not as good at all and just deny -

either way - the F3 vs the F5 - is just a motor change ? thats it ?

going the group 3 route and add the extras you wanted - does make it a bit easier to get it moving and approved without much push back from Medicare - once thats approved - your 2nd if medicaid usually follows and agrees also for the rest of it - in my case they didnt - and many others also

the fact is for sure that every user has a different story and some win - some loose -

there is a website you can go check on the court decisions of all cases - - you can read them and see who wins and who looses and figure out why the person who won - medical justification etc. could be helpful
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Re: group 4 chairs

Postby swalker » 31 Jan 2021, 22:41

Regarding a Group 4 wheelchair, Rollin Positive said:
Rollin Positive wrote:
When the orders were sent to Medicare they review it then send it to my insurance (Aetna Medicare Advantage) and it was approved 100% in 2 weeks!


I think the fact that Rollin Positive has a Medicare Advantage plan is a very key difference.

For those who don't know, in the US, Medicare is a government health insurance program available to qualifying folks over the age of 65 or who are sufficiently disabled.

Medicare has several options. Loosely stated, the base portion, called Part A and paid for by the Government, only covers 80% of the cost of treatment and then only for treatment provided in a hospital setting. An optional portion paid for by the patient, Parth B, provides coverage outside of a hospital setting, subject to a deductible.

A Medicare Supplement policy is an optional policy provided by an non-government insurance company, paid for by the patient, that provides varying degrees of standardized coverage, depending the option selected.

A Medicare Advantage policy replaces Medicare and must provide the same coverage as Medicare, but can optionally provide much more.

Most folks would either get a Medicare Advantage policy or get Medicare Parts A and B along with a Medicare Supplement policy (and potentially other options I have not mentioned)

Rolling Positive apparently has a Medicare Advantage policy, and his insurance company is apparently more lenient about which wheelchairs they will fund.

I have Medicare Parts A and B along with a Medicare Supplement policy. Neither Medicare Parts A and B nor my Medicare Supplement insurance company willingly cover a group 4 wheelchair, unless there is a medical necessity for a capability only available on the group 4 wheelchair. This must be a medical necessity for carrying out essential Activities of Daily Living (ADLS) inside my house.

So, why don't I have a Medicare Advantage policy if they appear to provide better coverage? Because none are available that would allow me to see doctors within 100 miles of where I live. So, I am essentially excluded from the Medicare Advantage policy market.

It is a confusing mess, but the bottom line is that getting "Medicare" to cover a group 4 wheelchair is quite the challenge, and in my case would have been 4 to 5 times more expensive than buying a used one.

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Re: group 4 chairs

Postby Burgerman » 01 Feb 2021, 00:03

Basically then. If you are disabled you need years of planning and a lawyer to define everything and fight in court. Who decides what is "disabled enough" for e.g?

and in my case would have been 4 to 5 times more expensive than buying a used one.


Esp if you plan and understand and keep your eyes open. I just bought a £12,660 UK chair, TECHNICALLY used as sold to another person, but with around 4 actual miles logged and 3 months old. It was for re-sale 2 of those! With the best options on everything ticked on the prescription form, delivered to my door for £4,400. A brand new chair with warranty for just 1/3rd the cost. And thats not even hard to do. And I can do this every 3 years. And the chair if far higher spec than anything the NHS would have provided.

So its even better in the UK to do that!
But your system seems so messy that even after reading all this I am just more bewildered.
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Re: group 4 chairs

Postby expresso » 01 Feb 2021, 00:28

doctor would define if your disabled etc, - with the fair hearings - you can submit all your docs. ahead of time - - so in the end you can represent yourself - or you can get someone to do it for you - with you present if you have to go to court - or can have a phone hearing

lawyers - you can get free help for these kinds of cases - i ending up having help to prepare docs to sent - then did it myself on the phone because of the pandemic - or else had to travel to them - i rather do the phone - but under normal conditions - you go there in person

unless you have docs. note that proves you cant travel etc, - i should start planning now for my next chair then :lol:
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Re: group 4 chairs

Postby ex-Gooserider » 02 Feb 2021, 06:47

FWIW, I'm on a couple of mailing lists for RESNA (the North American rehab manufacturers / dealers association) and a DME supplier magazine and according to them there is actually consideration underway to have Medicare cover seat lift / standing systems in power chairs... Much lobbying from the industry side, and they are also making a case that there is enough evidence of medical benefits to justify it....

The state level (but mostly federally funded) MedicAID systems are all over the map, with a lot of variation in what they will cover, etc. Again most are at some stage in considering coverage, but where they are in the process varies....

I am just dreading turning 65 in a couple more years and having to go on MedicARE instead of (or in addition to) Mass. Health, our state's MedicAID system...

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Re: group 4 chairs

Postby expresso » 02 Feb 2021, 06:56

thats correct - i also read that a short while back - didnt save the site etc and cant no longer find it - but its correct - and also they changed some wording that now allows outdoor usage of chairs - this will allow us to get outdoor chairs - meaning group 4 and its bill able coded for them will be allowed.

this is good finally -
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Re: group 4 chairs

Postby DSquare » 02 Feb 2021, 18:24

I've been following this thread. My son is due for a new chair this spring and he wants a group 4 mainly because of the additional speed. I found this on Cigna's website, dated April 2020, regarding funding for group 4 chairs.

Group 4 PWC with enhanced features for use outside the home (HCPCS code K0868–K0871, K0877–K0880, K0884–K0886) when the individual's mobility limitation is due to a neurological condition, myopathy, or congenital skeletal deformity and the Group 3 multiple power option criteria are met AND the enhanced features are needed for the individual to participate in the activities of daily living in school and/or employment*.

A Group 4 PWC (HCPCS code K0868–K0871, K0877–K0880, K0884–K0886) for use outside of the home for leisure or recreational activities is considered a convenience item and not medically necessary.


I would think since he is still in high school that would qualify him for a group 4 chair.
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Re: group 4 chairs

Postby Burgerman » 02 Feb 2021, 19:04

But who defines "needed"?
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Re: group 4 chairs

Postby expresso » 02 Feb 2021, 19:16

you may have a better chance now with the new rules - which allow outdoor use - mostly till now - it was what ever is needed for indoor use and didnt apply for outdoor use - which is riduculas - everyone will go out - they expect you to say home inside your whole life -

so with that in effect - start with your Doc. - go to a good Clinic that understands these new rules - if not make sure you tell them - a vendor who will work with you - For you - and good medical letter of justification - add in the seat lift - its a much needed item -

i think it be fine now - to get it passed - etc, - if not appeal - and go to a fair hearing - get some help to prepare you for it - documents etc,

i rather loose at a fair hearing then to loose by someone telling me no - i just did one - i won all the items i wanted on the chair - but one i didnt get approved - motors - - i quess i wasnt convincing enough to the judge - my case was really a flawed case from the start -

cant compare cases either - everyone may have difference insurances - yours may be better than mines - and may not have an issue from the start - mines is worse than my pervious ones - which i got group 4 chairs from in the past with no problems - so it will vary -

with the new changes and wording they added - an outdoor chair will be coded and allowed - in the past its hit and miss - some get it - some dont - more times you loose than win - so it has been discouraged to even start one - most wont even start it - because of the odds of wining were slim -

Clinics and vendors alike all like to go down the easy road - and are trained to discourage someone who dosnt agree and wants to go down the harder road and fight for it - its time consuming -

either way - i think it should be easier now moving forward with an outdoor chair - seat lifts etc, :thumbup:
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Re: group 4 chairs

Postby ex-Gooserider » 09 Feb 2021, 04:47

DSquare wrote:I've been following this thread. My son is due for a new chair this spring and he wants a group 4 mainly because of the additional speed. I found this on Cigna's website, dated April 2020, regarding funding for group 4 chairs.

Group 4 PWC with enhanced features for use outside the home (HCPCS code K0868–K0871, K0877–K0880, K0884–K0886) when the individual's mobility limitation is due to a neurological condition, myopathy, or congenital skeletal deformity and the Group 3 multiple power option criteria are met AND the enhanced features are needed for the individual to participate in the activities of daily living in school and/or employment*.

A Group 4 PWC (HCPCS code K0868–K0871, K0877–K0880, K0884–K0886) for use outside of the home for leisure or recreational activities is considered a convenience item and not medically necessary.


I would think since he is still in high school that would qualify him for a group 4 chair.


The key thing sounds like finding things he NEEDS to do in school (i.e. related to academics, not sports or after-school clubs) that he can't readily do with a Group 3 chair... How to define those things may be a challenge, especially in high school. My recollection (long time back and before I was hurt) was that HS was essentially indoor activities that didn't involve much that couldn't be handled by making the school provide "reasonable accommodations' as required by the ADA...

College would probably be easier to get justification since there are more activities on a campus (going between buildings, etc) and if living in a dorm or apartment presumably one could add in all the ADL's of general living that wouldn't count as 'in school' if living at home....

Just my guess...
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Re: group 4 chairs

Postby Rollin Positive » 09 Feb 2021, 06:05

DSquare wrote:I've been following this thread. My son is due for a new chair this spring and he wants a group 4 mainly because of the additional speed. I found this on Cigna's website, dated April 2020, regarding funding for group 4 chairs.

Group 4 PWC with enhanced features for use outside the home (HCPCS code K0868–K0871, K0877–K0880, K0884–K0886) when the individual's mobility limitation is due to a neurological condition, myopathy, or congenital skeletal deformity and the Group 3 multiple power option criteria are met AND the enhanced features are needed for the individual to participate in the activities of daily living in school and/or employment*.

A Group 4 PWC (HCPCS code K0868–K0871, K0877–K0880, K0884–K0886) for use outside of the home for leisure or recreational activities is considered a convenience item and not medically necessary.


I would think since he is still in high school that would qualify him for a group 4 chair.



When you say he is due for a new chair...can you explain?

Is he on your insurance or does he have his own?

Private or Medicare Medicaid?

What type of chair is he looking at?

Our community in the US have become or are extremely passive when it comes to our needs?

We seem to take what is told to us from this industry and the funding industry/insurance as the final word and never push back or rarely push back

In the last year I have talked with people that are looking for a big sign that says "Group 4 funding this way"

But we are dealing with an industry that rewards chair funding with commission so that dictates behavior

If a person can sell you a group 3 and get if covered vs a group 4 that he or she may have to work harder proving needs which do you think they will push?

As I posted before I was in a F3 bought by my wifes insurance with state of Arizona as I was getting ready to retire 2015

6 months out 5/2020 I started doing research on people that had group 4 chairs via social media and the common thread was nothing done special other then documentation of need which is the same as for group 3 and the orders placed for group 4 and not allowing the DME reps to downgrade to a group 3

Chairs funded Permobil F5's non stander, Permobil M5 (mid wheel) Frontier v6 and Bounder

I don't recall anyone was declined

3 months out I had a talk with both my NuMotion ATP and my local Permobil rep and both said I cant fund a group 4

I asked if I needed to go to a different DME (wheelchair store) and NuMotion said no

A month out I had a teleconference with my neurologist and he wrote up my needs sent the rx to the NuMotion rep

2 weeks out I had a in person meeting with PT/OT and the NuMotion rep and we went over chair model and features needed and they worked together on making sure there orders matched and at the end of that meeting the OT literally sent his order to Medicare a few weeks out NuMotion sent there's to Aetna (Medicare Advantage) NuMotion has to get the cost of each base and features and "k codes" added to there order

In 1 week it was 100% funded!

I think my point is in helping expresso last week we sent an email to the CEO of NuMotion who sent that email to the east coast VP who told me specify group 4 chairs can not be funded

But I just had a group 4 chair paid for 2 months earlier and the CEO was aware of it

So one end doesn't know what the other end is doing or what's being approved

Waiting for expresso to get his chair before I address group 4 again as not to mess up his order

But if I was you don't take no for an answer and put the order in at worse if it gets declined check with the insurance and some make you wait 6 months to resubmit others let you just put in for a group 3 after the denial
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Re: group 4 chairs

Postby Rollin Positive » 09 Feb 2021, 06:07

ex-Gooserider wrote:
DSquare wrote:I've been following this thread. My son is due for a new chair this spring and he wants a group 4 mainly because of the additional speed. I found this on Cigna's website, dated April 2020, regarding funding for group 4 chairs.

Group 4 PWC with enhanced features for use outside the home (HCPCS code K0868–K0871, K0877–K0880, K0884–K0886) when the individual's mobility limitation is due to a neurological condition, myopathy, or congenital skeletal deformity and the Group 3 multiple power option criteria are met AND the enhanced features are needed for the individual to participate in the activities of daily living in school and/or employment*.

A Group 4 PWC (HCPCS code K0868–K0871, K0877–K0880, K0884–K0886) for use outside of the home for leisure or recreational activities is considered a convenience item and not medically necessary.


I would think since he is still in high school that would qualify him for a group 4 chair.


The key thing sounds like finding things he NEEDS to do in school (i.e. related to academics, not sports or after-school clubs) that he can't readily do with a Group 3 chair... How to define those things may be a challenge, especially in high school. My recollection (long time back and before I was hurt) was that HS was essentially indoor activities that didn't involve much that couldn't be handled by making the school provide "reasonable accommodations' as required by the ADA...

College would probably be easier to get justification since there are more activities on a campus (going between buildings, etc) and if living in a dorm or apartment presumably one could add in all the ADL's of general living that wouldn't count as 'in school' if living at home....

Just my guess...
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Not true I am retired my needs didnt change from a F3 to a F5..
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Re: group 4 chairs

Postby benjamin » 10 Feb 2021, 05:46

ex-Gooserider wrote:FWIW, I'm on a couple of mailing lists for RESNA (the North American rehab manufacturers / dealers association) and a DME supplier magazine and according to them there is actually consideration underway to have Medicare cover seat lift / standing systems in power chairs... Much lobbying from the industry side, and they are also making a case that there is enough evidence of medical benefits to justify it....

The state level (but mostly federally funded) MedicAID systems are all over the map, with a lot of variation in what they will cover, etc. Again most are at some stage in considering coverage, but where they are in the process varies....

I am just dreading turning 65 in a couple more years and having to go on MedicARE instead of (or in addition to) Mass. Health, our state's MedicAID system...

ex-Gooserider


Commonwealth resident here. I’m in my 30s work full-time on commercial insurance but will say leave it to Rollin’ he knows his stuff. I actually just bought a spare F5 (non-VS new style) with all power functions, light package, and anterior tilt.

I would look at some of the SCO (Senior Care Options) plans from Tufts or Commonwealth Care Alliance. SCO (also known as a “DSNP” for Dual eligible special needs plan) combines your Medicare and Medicaid benefits. Tufts I believe covers Group 4 for both government and commercial but you should call member services and confirm.
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Re: group 4 chairs

Postby Burgerman » 10 Feb 2021, 10:29

Commonwealth, also called Commonwealth of Nations, formerly (1931–49) British Commonwealth of Nations, a free association of sovereign states comprising the United Kingdom and a number of its former dependencies who have chosen to maintain ties of friendship and practical cooperation and who acknowledge the British monarch as symbolic head of their association. In 1965 the Commonwealth Secretariat was established in London to organize and coordinate Commonwealth activities.


I am confused. You use the american super confused system?
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Re: group 4 chairs

Postby benjamin » 10 Feb 2021, 12:17

Burgerman wrote:
Commonwealth, also called Commonwealth of Nations, formerly (1931–49) British Commonwealth of Nations, a free association of sovereign states comprising the United Kingdom and a number of its former dependencies who have chosen to maintain ties of friendship and practical cooperation and who acknowledge the British monarch as symbolic head of their association. In 1965 the Commonwealth Secretariat was established in London to organize and coordinate Commonwealth activities.


I am confused. You use the american super confused system?


Commonwealth of Massachusetts. It’s the official and full state name. Appears on our drivers, professional licenses, correspondence from state, etc.

There are four commonwealth states in the US:
1) Massachusetts
2) Virginia
3) Pennsylvania
4) Kentucky
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Re: group 4 chairs

Postby Rollin Positive » 11 Feb 2021, 18:19

swalker wrote:Regarding a Group 4 wheelchair, Rollin Positive said:
Rollin Positive wrote:
When the orders were sent to Medicare they review it then send it to my insurance (Aetna Medicare Advantage) and it was approved 100% in 2 weeks!


I think the fact that Rollin Positive has a Medicare Advantage plan is a very key difference.

For those who don't know, in the US, Medicare is a government health insurance program available to qualifying folks over the age of 65 or who are sufficiently disabled.

Medicare has several options. Loosely stated, the base portion, called Part A and paid for by the Government, only covers 80% of the cost of treatment and then only for treatment provided in a hospital setting. An optional portion paid for by the patient, Parth B, provides coverage outside of a hospital setting, subject to a deductible.

A Medicare Supplement policy is an optional policy provided by an non-government insurance company, paid for by the patient, that provides varying degrees of standardized coverage, depending the option selected.

A Medicare Advantage policy replaces Medicare and must provide the same coverage as Medicare, but can optionally provide much more.

Most folks would either get a Medicare Advantage policy or get Medicare Parts A and B along with a Medicare Supplement policy (and potentially other options I have not mentioned)

Rolling Positive apparently has a Medicare Advantage policy, and his insurance company is apparently more lenient about which wheelchairs they will fund.

I have Medicare Parts A and B along with a Medicare Supplement policy. Neither Medicare Parts A and B nor my Medicare Supplement insurance company willingly cover a group 4 wheelchair, unless there is a medical necessity for a capability only available on the group 4 wheelchair. This must be a medical necessity for carrying out essential Activities of Daily Living (ADLS) inside my house.

So, why don't I have a Medicare Advantage policy if they appear to provide better coverage? Because none are available that would allow me to see doctors within 100 miles of where I live. So, I am essentially excluded from the Medicare Advantage policy market.

It is a confusing mess, but the bottom line is that getting "Medicare" to cover a group 4 wheelchair is quite the challenge, and in my case would have been 4 to 5 times more expensive than buying a used one.

Steve



Steve in talking back and forth I am sure you told me but the chair that was stolen was a F5? Cash buy or insurance?
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Re: group 4 chairs

Postby Rollin Positive » 11 Feb 2021, 18:22

benjamin wrote:
ex-Gooserider wrote:FWIW, I'm on a couple of mailing lists for RESNA (the North American rehab manufacturers / dealers association) and a DME supplier magazine and according to them there is actually consideration underway to have Medicare cover seat lift / standing systems in power chairs... Much lobbying from the industry side, and they are also making a case that there is enough evidence of medical benefits to justify it....

The state level (but mostly federally funded) MedicAID systems are all over the map, with a lot of variation in what they will cover, etc. Again most are at some stage in considering coverage, but where they are in the process varies....

I am just dreading turning 65 in a couple more years and having to go on MedicARE instead of (or in addition to) Mass. Health, our state's MedicAID system...

ex-Gooserider


Commonwealth resident here. I’m in my 30s work full-time on commercial insurance but will say leave it to Rollin’ he knows his stuff. I actually just bought a spare F5 (non-VS new style) with all power functions, light package, and anterior tilt.

I would look at some of the SCO (Senior Care Options) plans from Tufts or Commonwealth Care Alliance. SCO (also known as a “DSNP” for Dual eligible special needs plan) combines your Medicare and Medicaid benefits. Tufts I believe covers Group 4 for both government and commercial but you should call member services and confirm.


Ben Thank you for the kind words..

I think more then anything I just fight more then most!

So on your chair you funded it through your work insurance correct?

What did you have before the F5?

How are you liking the F5? Pros and Cons?
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Re: group 4 chairs

Postby swalker » 11 Feb 2021, 20:29

Rollin Positive wrote:Steve in talking back and forth I am sure you told me but the chair that was stolen was a F5? Cash buy or insurance?


The chair was an F5. I found it on craigslist and purchased it used for cash.

This was after I spent 9 months working with NuMotion to get Medicare (primary) and United Healthcare (secondary) insurance to fund an F5. They finally agreed to fund an F5, but only if I got the standing version and only if I paid for the standing feature (plus other normal out of pocket costs). My out of pocket would have been between $18,000 and $20,000. They said it was impossible to know my exact out of pocket amount until after the sale was completed.

I gave up on trying to buy an insurance-funded wheelchair and started looking for a used one.

Since that time, I have rolled off of the United Healthcare as a secondary medical insurance and have replaced it with a Medicare Supplemental (Medigap) policy.

For those who have not followed my story, my F5 was stolen over Thanksgiving of 2019. It was recovered a few days later, but my homeowner's insurance company deemed it to be beyond economic repair. I have been working since then to get a replacement wheelchair (another F5), but due to an unbelievable combinations of delays and problems, I still don't have a replacement for the F5.

Fortunately, I have other wheelchairs I can use while continuing to sort this out.

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Re: group 4 chairs

Postby expresso » 13 Feb 2021, 03:16

https://icsny.org/disability-advocates- ... d-changes/

means outdoor chairs can be billed allowed - means group 4 - i am sure insurance may still push back - its new and they all will be notified by the state - if they deny - fair hearing will approve anyway - so if you doing a chair today -

and you need a group 4 outdoor chair - insist on one with the vendor - who ever it may be - if they say no - show them this and if they dont want to place the order - find another vendor and report them - file a complaint etc, -

change always take some time for all parties to get used to the new norm. :thumbup:
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Re: group 4 chairs

Postby swalker » 13 Feb 2021, 19:56

expresso wrote:https://icsny.org/disability-advocates-praise-new-york-state-medicaid-changes/

means outdoor chairs can be billed allowed - means group 4 - i am sure insurance may still push back - its new and they all will be notified by the state - if they deny - fair hearing will approve anyway - so if you doing a chair today -

and you need a group 4 outdoor chair - insist on one with the vendor - who ever it may be - if they say no - show them this and if they dont want to place the order - find another vendor and report them - file a complaint etc, -

change always take some time for all parties to get used to the new norm. :thumbup:


If you are in new New York and on Medicaid. Hopefully, Medicare and other states will follow their lead.

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Re: group 4 chairs

Postby expresso » 13 Feb 2021, 20:04

https://www.health.ny.gov/health_care/m ... 12.htm#dme


yes i am in NY - i am sure some or most 2nd insurances may still deny - for some reason but should have it reversed at a fair hearing if they do -
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Re: group 4 chairs

Postby benjamin » 14 Feb 2021, 01:36

Rollin Positive wrote:
benjamin wrote:
ex-Gooserider wrote:FWIW, I'm on a couple of mailing lists for RESNA (the North American rehab manufacturers / dealers association) and a DME supplier magazine and according to them there is actually consideration underway to have Medicare cover seat lift / standing systems in power chairs... Much lobbying from the industry side, and they are also making a case that there is enough evidence of medical benefits to justify it....

The state level (but mostly federally funded) MedicAID systems are all over the map, with a lot of variation in what they will cover, etc. Again most are at some stage in considering coverage, but where they are in the process varies....

I am just dreading turning 65 in a couple more years and having to go on MedicARE instead of (or in addition to) Mass. Health, our state's MedicAID system...

ex-Gooserider


Commonwealth resident here. I’m in my 30s work full-time on commercial insurance but will say leave it to Rollin’ he knows his stuff. I actually just bought a spare F5 (non-VS new style) with all power functions, light package, and anterior tilt.

I would look at some of the SCO (Senior Care Options) plans from Tufts or Commonwealth Care Alliance. SCO (also known as a “DSNP” for Dual eligible special needs plan) combines your Medicare and Medicaid benefits. Tufts I believe covers Group 4 for both government and commercial but you should call member services and confirm.


Ben Thank you for the kind words..

I think more then anything I just fight more then most!

So on your chair you funded it through your work insurance correct?

What did you have before the F5?

How are you liking the F5? Pros and Cons?


No, the F5 I just got secondhand is a back-up to leave at my second home. I’m not due for an insurance paid chair for several years. I also have an M3, have also had an M300 and Pronto M91 before so all mid wheel drive.

So far the F5 has been all positive minus some cosmetic damage in shipping to the cosmetic covers. The ergo air cushion is great, new lights are great, and the speed is fantastic. I haven’t take it outside yet with the weather.

Great you are encouraging people to be proactive, take ownership and be persistent.
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Re: group 4 chairs

Postby ex-Gooserider » 16 Feb 2021, 01:31

Rollin Positive wrote: (Much trimmed)

Our community in the US have become or are extremely passive when it comes to our needs?

We seem to take what is told to us from this industry and the funding industry/insurance as the final word and never push back or rarely push back

In the last year I have talked with people that are looking for a big sign that says "Group 4 funding this way"

But we are dealing with an industry that rewards chair funding with commission so that dictates behavior

If a person can sell you a group 3 and get if covered vs a group 4 that he or she may have to work harder proving needs which do you think they will push?

As I posted before I was in a F3 bought by my wifes insurance with state of Arizona as I was getting ready to retire 2015

6 months out 5/2020 I started doing research on people that had group 4 chairs via social media and the common thread was nothing done special other then documentation of need which is the same as for group 3 and the orders placed for group 4 and not allowing the DME reps to downgrade to a group 3

Chairs funded Permobil F5's non stander, Permobil M5 (mid wheel) Frontier v6 and Bounder

I don't recall anyone was declined

3 months out I had a talk with both my NuMotion ATP and my local Permobil rep and both said I cant fund a group 4

I asked if I needed to go to a different DME (wheelchair store) and NuMotion said no

A month out I had a teleconference with my neurologist and he wrote up my needs sent the rx to the NuMotion rep

2 weeks out I had a in person meeting with PT/OT and the NuMotion rep and we went over chair model and features needed and they worked together on making sure there orders matched and at the end of that meeting the OT literally sent his order to Medicare a few weeks out NuMotion sent there's to Aetna (Medicare Advantage) NuMotion has to get the cost of each base and features and "k codes" added to there order

In 1 week it was 100% funded!

I think my point is in helping expresso last week we sent an email to the CEO of NuMotion who sent that email to the east coast VP who told me specify group 4 chairs can not be funded

But I just had a group 4 chair paid for 2 months earlier and the CEO was aware of it

So one end doesn't know what the other end is doing or what's being approved

Waiting for expresso to get his chair before I address group 4 again as not to mess up his order

But if I was you don't take no for an answer and put the order in at worse if it gets declined check with the insurance and some make you wait 6 months to resubmit others let you just put in for a group 3 after the denial


My opinion, but I think one of the reasons why "the community" is so passive in the US is that the group that claims to be our representative / rights leader, namely United Spinal Assoc., seems both to be very much in the "Power chairs are only for those that are to handicapped to self propel" camp, and very much in the pocket of the Rehab manufacturers....

On the first point - note what the editors and those that get published in New Mobility are saying their disabilities are and what they are using.... I have NEVER seen one thing published in New Mobility suggesting that there be any consideration of options other than a manual chair if one can self propel...

Not to speak ill of the departed, but remember who was their go to guy for 'technology'? Who claimed there was no such thing as OEM level programmers? When have they ever published anything CRITICAL of chair manufacturers? OTOH lots of puff pieces that looked like they were pulled from press releases...

I can't 100% say I blame them, given the amount of money they get from advertising and presumably other donations from the chair makers, it is understandable that one doesn't want to bight the hand that funds them... At the same time, it means they do a lousy job of promoting our interests in terms of getting better mobility products...

However it also means that the average chair user will look at the stuff that they are doing in regards to gov't relations, (RoCH, etc) ADA promotion, etc. and feel that they must be doing all they can for our interests on chairs as well...

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Re: group 4 chairs

Postby Rollin Positive » 16 Feb 2021, 19:09

I hear you, I dont think myself in the US its any one group or person but I do think that the mobility industry as a whole is broken and run by non disabled so it makes it hard because they are all about selling units so if they can fund a group 3 faster and someone is making commission of those sales its a proven fact that when money is involved it dictates behavior

Are we talking Mark Smith?

Having a talk with expresso now he is the perfect example of the @#*# up system

He was up for a chair and wanted a faster group 4 chair but has a ATP with NuMotion that is just an idiot

So he convivences expresso that its not going to fund and expresso having used this jerk in the past trust what he tells him

A year goes by!!! A year.. that is nuts, I can get chairs funded for others in 90 days and because this idiot doesn't put in the paperwork right doesn't follow up with the other company involved it denies, goes in to appeals and even court!

If we don't learn to say NO that's not what I want...No I am not going to let you treat me like @#Z(, NO that's not how this is going to work you are working for me on this order...

Its never going to get better.

People and business treat us the way we allow them to.

Try something different be a disrupter when it comes to mobility!

People chairs in the US fund in 90 days PERIOD

Group 4 chairs are a possibly on Medicare I know I am one who just funder 100% including seat elevation

Last if your on Medicare please sign up for a Medicare Advantage plan!!!

The fund better and you get extra coverage like eye glasses and dental...

Please reach out to me before you start your orders willing to help anyone no charge!

RollinPositive@gmail.com
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Re: group 4 chairs

Postby expresso » 16 Feb 2021, 19:29

yes i feel Numotion should have - could have done more to get this moving - lets not forget - its your insurance that will either make it easy for you or not - and mines did not make it easy - they denied two appeals - means months go by - i am left with doing a fair hearing - which means many more months go by -

90 days only works if all goes smooth - paper works gets done and sent in to insurances - the moment the insurances get the order - it then can 30 to 45 days to get approved or denied - if both your insurances are so great and both approve it - then yeah you have a chair in 90 days - but that dosnt happen in real life 90% of the times

i hear more and more stories of the process taking much longer now - even if we take Numotion out of the picture -for a moment - its also the Clinic you visit that has to do paper work - in my case its was i believe both the Clinic and Numotions fault for many things - but what delayed mines was the insurance who denied it twice -

its very similar to what happens in the UK - BM gets chairs and payments sent to him to do as he wants - and the rest of them never get the same deal - it actually seems worse there with the chairs they are being offered 4mph chairs - thats ridiculous even for in door use -

unless you really need a group 4 chair for some reason - i wont even stress it make your life difficult for nothing - but if you do need one - then do it - just be prepared -
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Re: group 4 chairs

Postby Rollin Positive » 16 Feb 2021, 23:31

expresso wrote:yes i feel Numotion should have - could have done more to get this moving - lets not forget - its your insurance that will either make it easy for you or not - and mines did not make it easy - they denied two appeals - means months go by - i am left with doing a fair hearing - which means many more months go by -

90 days only works if all goes smooth - paper works gets done and sent in to insurances - the moment the insurances get the order - it then can 30 to 45 days to get approved or denied - if both your insurances are so great and both approve it - then yeah you have a chair in 90 days - but that dosnt happen in real life 90% of the times

i hear more and more stories of the process taking much longer now - even if we take Numotion out of the picture -for a moment - its also the Clinic you visit that has to do paper work - in my case its was i believe both the Clinic and Numotions fault for many things - but what delayed mines was the insurance who denied it twice -

its very similar to what happens in the UK - BM gets chairs and payments sent to him to do as he wants - and the rest of them never get the same deal - it actually seems worse there with the chairs they are being offered 4mph chairs - thats ridiculous even for in door use -

unless you really need a group 4 chair for some reason - i wont even stress it make your life difficult for nothing - but if you do need one - then do it - just be prepared -
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Re: group 4 chairs

Postby Rollin Positive » 16 Feb 2021, 23:40

expresso wrote:yes i feel Numotion should have - could have done more to get this moving - lets not forget - its your insurance that will either make it easy for you or not - and mines did not make it easy - they denied two appeals - means months go by - i am left with doing a fair hearing - which means many more months go by -

90 days only works if all goes smooth - paper works gets done and sent in to insurances - the moment the insurances get the order - it then can 30 to 45 days to get approved or denied - if both your insurances are so great and both approve it - then yeah you have a chair in 90 days - but that dosnt happen in real life 90% of the times

i hear more and more stories of the process taking much longer now - even if we take Numotion out of the picture -for a moment - its also the Clinic you visit that has to do paper work - in my case its was i believe both the Clinic and Numotions fault for many things - but what delayed mines was the insurance who denied it twice -

its very similar to what happens in the UK - BM gets chairs and payments sent to him to do as he wants - and the rest of them never get the same deal - it actually seems worse there with the chairs they are being offered 4mph chairs - thats ridiculous even for in door use -

unless you really need a group 4 chair for some reason - i wont even stress it make your life difficult for nothing - but if you do need one - then do it - just be prepared -


I was just watching a documentary on Harvey Weinstein and why do you think once he and Bill Cosby had been found guilty you then see them going back to court for sentencing in a beat up old wheelchair or walker?

Is it because our community is looked upon as passive and helpless?

Not sure where your getting your information? Things like 30-45 days please look at a bigger picture had Pete done his job we would not be talking about this...

Mine was 4 days...I just helped a family in San Francisco theirs was less then a week.

Remember as I have told you your ATP never followed up with the orders and information input wrong and no follow though plus your main chair and back up chair were labeled incorrectly causing denials

His own VP of East coast NuMotion said...Perhaps we could have been more proactive

I think you said you had problems before with him, you knew he blew us off when we asked for a demo in a Frontier v6, remember we teach people and business how to treat us.

History repeats itself next time please use another ATP

Here is the worse news a few months after you get your chair and its funded he gets a commission so he is rewarded for crappy service

We have to do research...orders only decline on 2 basic issues lack of documentation, lack of medical need which goes back to the 1st reason the proper medical needed documentation

We many times are the key component of the delays because we are not involved with the order

When one starts an order in the US we need to get timelines example I did a seating evaluation and the ordering of the chair at the same time.

The OT/PT literally sent his order to Medicare as I sat there.

I asked the NuMotion sales person how long his would take and he had to send it to coding to get each feature priced and code 5 days and he emailed me once it was done and sent to Aetna

I can watch my order with Aetna pending each day and on the morning of day 4 it showed approved

I then called Aetna and had the executive team confirm all features approved with 100% coverage.

I then emailed the sales person and the GM of that office to get time lines.

They said 2 weeks so on week one I checked back and found out some crazy employee stalled the order because she didn't believe a group 4 chair could be funded

Had I not been all over the order these are things that cause delays

She was removed from handling my order and we had a week delay but now they pushed it forward.

Realize when you say I would get a group 3 vs 4 chair less hassle that is the point we become passive and don't want to stand up

That is the reason to use advocates they stand up for those that done feel comfortable with being assertive

If I recall you where in 6-8 months before you went to a manager you got upset and became a DISRUPTER!

You have done more for yourself in the last 30 days its amazing and now your chair is soon on its way to you!

Remember that in 2026

Plus in Sept sign up for a Medicare advantage plan too

BM is the perfect roll model he know what he wants and doesn't take @#@# from companies
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Re: group 4 chairs

Postby expresso » 16 Feb 2021, 23:54

its not as simple as you say - just sign up for Medicare Advantage - that affects my home care services also - i am not looking to disrupt that part - each person has there own reasons for staying with a plan or changing - sure one plan can be better with chairs - and then suck with home care services end -

anyway - dosnt matter - its done- when i get it - i take it and move on - worry about it in 5 years or 7 years or 9 years - i dont care much as long as i have enough chairs all fitted and working for me - i am fine - yes Numotion - Clinic had alot to blame for my order - but insurance delayed that even more by many months - no one can do anything about that - then the courts - takes time -

anyway you are the first i know of that has stories of users getting chairs in weeks - how many users got there chairs that fast ? i be willing to bet - not many - at least not here in NY - that i know of -- the only times i got my chairs fast with no stress or fighting for what i want etc, group 4 chairs - is when my Insurance paid for them no questions - 646se and bounder - i didnt have to fight for anything

the Insurance is the key they can pay fast and approve it or take months to deny first - once and twice - then off to court etc , also Medicare did not approve the bounder --- there is no coding for bounder chairs -- UP to now 300M bounder is now coded and billable - but not mines - even today wont get approved from medicare

anyway -- anyone needs help - ask rolling - he knows more than me - i can just tell you how it went for me -- this time it went bad -- previous times no problems -- insurance matters
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Re: group 4 chairs

Postby swalker » 17 Feb 2021, 01:56

Rollin Positive, I am glad things worked out for you. They have and will continue to not work out for me. Here is why.

1. Medicare Advantage is not practically available to me. The closest doctor would be 100 miles away. I must do something else, and in my case that is a Medicare Supplement policy.
2. NuMotion was slow but got things done 3 years ago. About 1.5 years ago, there was a turnover in the local staff. Most of the good folks are gone. Those that remain are just not able to get things done.

The closest NuMotion office to me is 100 miles away. I worked with them for 9 months to try to buy, for cash, a new wheelchair. No insurance was involved, no approvals were needed. After 9 months, I finally gave up and tried to switch to a different NuMotion office that is 150 miles away. I was told I could NOT switch, because it is like a car dealership. Once I start working with one salesperson, that salesperson owns the commission on that wheelchair, so no other salesperson will help. I could not switch to a different salesperson no matter how hard I tried.

So, what am I supposed to do? NuMotion is so broken that they cannot serve my needs. There is only one alternative provider within 200 miles of me, and I am not convinced they are any better.

That is why I have decided to bypass the new wheelchair market and buy used wheelchairs. Once I find a wheelchair I want it can be mine in a few days. I drive just as far (typically about 100 miles) as I would to work with NuMotion. Instead of making 5 trips to NuMotion and not get a wheelchair, I only have to make one trip to buy a used wheelchair.

The system is broken in the US. Medicare certainly needs to change their rules, but in my opinion, NuMotion is the real culprit. They are a monopoly player, having bought up or driven out of business their competition (at least where I live). They behave like a monopoly, which makes them difficult to deal with.

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Re: group 4 chairs

Postby expresso » 17 Feb 2021, 04:48

yes i agree - Numotion is in charge - and not many other vendors to use - its like Cable - your stuck with the one in your area and thats it

but in your case - you should have reached out to the top CEO - investors - you would have to gotten it done ASAP after that -

i did that with Rollings help - i decided to have rolling step in and reach out to the top and let them come down on there VPs and GM and salesperson -

if i didnt have rolling - i had a letter written and ready to send to the top guys myself and another investor of Numotion - the investor dosnt want to hear bad news - i have once before reached out to investor and i got a call next morn.

this time around i had rolling step in - paying out of pocket should have given you priority and taken care of right away -

we are screwed - who else is there other than Numotion ? i already had it out with Medstar 20 years ago and left them for ATG which is now Numotion also - maybe theres 2 other vendors and both suck also - HME - and the other i dont know the name -

Numotion is the only one that does in home repairs - only real reason i am sticking with them at the moment - i dont want to give up my chair for repair - and i like this one Tech. i only use him -
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