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
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.
swalker wrote: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.
Steve
Rollin Positive wrote:
did you get the x8 I sent you its a good price dont worry if your not in to the camo I can teach you a simple color change its cool product I worked with the company its $12 cost and it sprays on and when your done and want to do a new color it peels off super durable
Oh also it didnt go well my new Permobil F5 had problems so I demanded under the AT Lemon law it be replace new F5 coming 2 weeks!
swalker wrote:Rollin Positive wrote:
did you get the x8 I sent you its a good price dont worry if your not in to the camo I can teach you a simple color change its cool product I worked with the company its $12 cost and it sprays on and when your done and want to do a new color it peels off super durable
Oh also it didnt go well my new Permobil F5 had problems so I demanded under the AT Lemon law it be replace new F5 coming 2 weeks!
I did not go after that X8 for 2 reasons. First, I am not going to be wheelchair shopping until I get a COVID vaccine and the COVID menace has subsided a bit. Second, It is an older X8 with the Dynamic Controls rather than RNet system. I am looking for one with RNet. Camo is not a problem for me. My X4 is camo.
Sorry you had to return the F5. What were the problems with it that caused you to invoke the lemon law?
Steve
Have had 5 + service calls even replaced the joystick no go
Rollin Positive wrote: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?
ex-Gooserider wrote:Rollin Positive wrote: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?
Who else appeared in virtually every issue of New Mobility as their "Power Chair EXPERT" and general commentator on mobility tech???
ex-Gooserider
Rollin Positive wrote:
I have to tell you being friends with him on a personal level the looking back after defriending him he was a man confused and 100% caught up in his celebrity!
Rollin Positive wrote:ex-Gooserider wrote:Rollin Positive wrote: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?
Who else appeared in virtually every issue of New Mobility as their "Power Chair EXPERT" and general commentator on mobility tech???
ex-Gooserider
I have to tell you being friends with him on a personal level the looking back after defriending him he was a man confused and 100% caught up in his celebrity!
He said he was for the people but more was used by many for parts and free batteries
He also lost track of what endusers wanted and needed and was way to fast to defend Pride power chairs vs listen and take critical feedback
To kick enusers off his website too was an interesting way to deal with people that had other ideas different then his
I can remember him being so behind the Edge series chair that had small nf22 batteries why would any mobility manufacture put that small of a battery in a power chair and limit you rider to 6-8 miles?
DSquare wrote:I started the process and made an appointment for a new evaluation for son. The eval is not till two weeks from now but I started emailing the DME provider about getting a group 4 chair. They are adamant that insurance would only cover group 3 chairs. Only in extreme rare cases when the stars align just right that will a group 4 get through insurance. They weren't even willing to call and find out for themselves.
I took it upon myself to call and after getting to a department that understood the different groups of power chairs I was then informed that as along as the doctor says it is medically necessary a group 4 will be covered. So at least it is a start in the right direction.
Return to Everything Powerchair
Users browsing this forum: No registered users and 288 guests