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group 4 chairs

Postby Rollin Positive » 30 Jan 2021, 02:42

Looking for people in the USA that have group 4 chairs like Frontiers v6, v4s, Permobil F5 none standers etc. 

That were funded with Medicare, Medicare Advantage or Medicaid

​​​​​​​Just seeing who you used as a DME and what your experience was...
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Re: group 4 chairs

Postby Burgerman » 30 Jan 2021, 03:19

Whats the definition of group 1,2,3 or 4 chairs. And how does it matter? Who gets what and why. What are the rules. Anyone that can give a simple clear definition of this would be welcome! I am always bewildered by it all.

For e.g. some get 12mph chairs like the bounder, and backup chairs. Like expresso. Others dont seem to get anything.
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Re: group 4 chairs

Postby swalker » 30 Jan 2021, 05:43

In 2019, I was approved through Medicare for a Permobil F5 VS (standing) wheelchair.

I was approved for an F5 because I had a medical need for a standing wheelchair and what I needed was only available in the F5.

The catch was that while Medicare would pay for the F5, they would NOT pay for the actual standing capability. I would have had to pay for that out of pocket.

The cost of the standing feature plus the other normal out of pocket stuff was going to be $18,000 to $20,000. Medicare (via NuMotion) said they could not tell me the exact amount until after the wheelchair was delivered.

I inquired about declining the standing feature and they said in that case I would only qualify for an F3.

I worked with NuMotion/Medicare for over 9 months and finally realized I was not going to win. At that time, I found a used F5 (non stander) about a 3 hour drive away. I bought that used wheelchair and gave up on having Medicare fund a wheelchair that would suit my needs.

This experience reinforced my idea that trying to get Medicare to pay for a useful wheelchair is at best a challenge. Coupled with the miserable experiences I have had when trying to work with Durable Medical Equipment (DME) providers when trying to buy a new wheelchair has convinced me that I am far better off buying a low-mileage used wheelchair than going through the brain damage of dealing with the stupid US insurance system.

I know of one other person who had the same medical condition I do who also qualified through Medicare for an F5 VS. They paid out of pocket for the standing feature. Otherwise, they reported they would have only received Medicare funding for an F3.

There is a possibility that a Medicare Supplement (Medigap) policy would cover part or all of the standing feature for those who qualify for an F5 VS.

Steve
Permobil F5 Corpus 3G
Permobil C500s VS
Permobil C500 Corpus 3G
Permobil C350 Corpus 3G
Magic Mobility X4 with 176 Ah LiFePO4
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Re: group 4 chairs

Postby swalker » 30 Jan 2021, 06:10

Burgerman,

Wheelchair groups are a thing used by the US insurance industry. I suspect they originated with the government programs of Medicare and Medicaid and are now used by most health insurance providers.

In the US, there are 5 groups:

Group 1 - Light weight PWC. All folding PWCs are group 1
Group 2 - More capable, but still very limited PWCs. Suitable for patients weighing up to 300 pounds
Group 3 - The most capable PWC Medicare will typically fund. A wheelchair that is suitable for use inside a patient's residence. An example would be the Permobil F3
Group 4 - A more capable PWC, especially one capable of being used outside the patient's home. An example would be the Permobil F5
Group 5 - A pediatric PWC

Medicare will only pay for the minimum wheelchair a patient needs for "essential Activities of Daily Living" (ADLs). Essential ADLs are limited to those things that can be done inside a patient's residence, so Medicare will only fund Group 1, 2, or 3 wheelchairs. Medicare will not fund a Group 4 wheelchair, except in very rare circumstances.

In addition, Medicare will typically not pay for power seat elevate, lights, or anything else that is not directly needed for essential ADLs.

Various folks have been able to get Medicare to pay for group 4 wheelchairs, but those seem to be rare cases. It does seem to be happening more often now that it did a few years ago.

It is a truly messed up system!

Steve
Permobil F5 Corpus 3G
Permobil C500s VS
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Re: group 4 chairs

Postby expresso » 30 Jan 2021, 06:36

its not the same for everyone and depends on many factors - Insurance is the main thing - but thats not the whole story either

the rules have been updated now - wording so as of feb. 1 - medicaid medicare is allowed to fund whats considered an outdoor chair - which in reality is a group 4 chair - thats considered outdoors -

up till now - only indoor chairs covered - which are group 3 - - BUT depending on your 2nd insurance - if Medicare denied it - your 2nd can pick up the difference - Most of them DONT so if Medicare denies it - the 2nd insurance will follow and deny it also -

then your stuck either paying the difference if you still want the items or features denied - or for example like what just happened to me - is appeal - all the time - appeal and go to court for a fair hearing - if you can make the case for those denied items - and the judge agrees - you win and they have to pay for them - in my case the seat lift and some other items like Rnet 120A - color JS - latest one with BT etc,

i did loose on one item - the high speed motors - so i wont be getting them this time around -

i read some of the cases - they are posted - and some loose at court also - for the seat lift - and some win - depends how much of a case you can make for the need and i guess who reads it and decides if they believe you or not -

so best thing to do is - try - appeal if denied and go to a fair hearing and let the judge decide - thats the final answer - - takes time stressful

its been a full year since i started the process - i am 99% done now - should get it in a month if nothing else goes wrong - which i wont be surprised at this point - it was alot of bullshit between the Clinic i used - Vendor - etc, - paper work wrong - a few times from the Clinic -

i had to force the clinic to fix the paperwork - they didnt feel it was so urgent - after knowing and showing them it the mistakes - even though they agreed - they said it wont matter either way - oh really - with my 2nd insurance - i agreed - they just deny everything anyway - but thats not the point - it was incorrect and needed to be correct either way -

But going forward now - the rules have changed- you should be able to make a case for an outdoor chair which is usually a group 4 - a bit late for me - but its ok - i put some magnets on my motors once BM figures it out :joint
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Re: group 4 chairs

Postby expresso » 30 Jan 2021, 06:47

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

new rules - home and/or community. Please Note: New York State Medicaid funds and maintains one medically necessary manual mobility device to meet the member's medical needs whether primarily used in the home, community, or as a back-up to the primary Power Wheelchairs (PWC).

the wording changed just a bit so that it now allowed to be funded and paid - they will notify all the insurances going forward -

i am sure they will try to avoid paying one way or another - but you will win in court if they do - and they will get in trouble if they do that often enough -

home and or community - key words - also community or as a back up to the primary - also sounds like a back up chair will also be covered -

if you already have one - not sure if they will pay for a back up also - maybe - depends how its interpreted -

i hate that these rules are never really clear - why cant you just say - YES you can get a outdoor chair group 4 if you meet the needs for one period - or YES you can get a back up chair period

its always a thin line that can be a problem and denied - some will fight - some wont - and they bet on those odds
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Re: group 4 chairs

Postby Burgerman » 30 Jan 2021, 11:21

I thought we had a messed up system!

Group 3 - The most capable PWC Medicare will typically fund. A wheelchair that is suitable for use inside a patient's residence. An example would be the Permobil F3
Group 4 - A more capable PWC, especially one capable of being used outside the patient's home. An example would be the Permobil F5

Whats the difference in those chairs? They look initially very similar. As far as rules? What decides?
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Re: group 4 chairs

Postby expresso » 30 Jan 2021, 14:51

if you ask me nothing is different in most chairs between group 3 and 4 - usually its the speed - motors - PM are usually 120A if its a sunrise chair - thats about it - JS options -

with the new rules - it will give us more chair options -

Sunrise here is - dont care much about RWD chairs - they never update there order form - so for example - my new chair - has grey tires - i asked them to give me black instead - i know sunrise has them - but they are not on the 636 order form -

they have them for there MWD and FWD chairs - you would think whats the big deal - the big deal is that someone at sunrise then has to take apart a rim tire - replace the grey with the Black - thats work that no one wants to do - so they said they cant do it - it has to ship with the grey tires -

now the reason being is - the 636 chair rims are different than the MWD and FWD rims - meaning they get rimes and tires already mounted for each chair - its just lazy no one wants to work and sunrise dosnt update the RWD chairs with black tires as an option -

that goes the same for the JS - i did manage to get the CJSM2 BT large screen etc, - that was pulling teeth also - not on the order form as an option and was told at first - it dosnt work on that chair - :lol: this is the sunrise Rep. just lazy - i managed to get it - since its a plug and play item - they did it - but the tires is a little work - so much for custom chairs - nothing is custom about them -

they have updated there swing away i heard - 6 months back - suppose to be more flexible i am told - we see when i get it - how sturdy it is

they think we are stupid and dont know better - just tell us it wont work on the chair - they would tell your vendor that - your vendor would tell you that - and maybe most users wont give it much though and just say Ok - that is just one example and no work involved at all to plug one JS in instead of another JS -

glad i got it - court approved it so maybe thats why also -
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Re: group 4 chairs

Postby Burgerman » 30 Jan 2021, 17:12

I dont get it.

Black tyres were a definite no 20 years ago and everyone, manufacturers and users alike were all horrified by me saying use them! Everything was grey. Now the manufacturers and users alike all want them! Seems they woke up 20 years late. And the US is 20 years behind, and doesent even have any rear drive otions. Likewise the centre footplate - and power centre footlpate options are missing even on the Q500 chair in the US and no Q700 at all.

Did I start a trend? No idea. Now EVERYTHING is black!

But... SUNRISE MEDICAL, or QUICKIE if you prefer... Now ONLY show black tyres on every chair! And note that this includes all of these QUICKIE rear drive chairs:
https://www.sunrisemedical.co.uk/powere ... heelchairs
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Re: group 4 chairs

Postby expresso » 30 Jan 2021, 17:14

yes they do over there - not here in the US -
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Re: group 4 chairs

Postby Burgerman » 30 Jan 2021, 17:25

Thats what I said. But why?

Only 2 rear drive chairs, old designs available with few seating and footrest options on USA site. https://www.sunrisemedical.com/power-wh ... heel-drive and its the same company! Must be to do with insurance or risk or something.
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Re: group 4 chairs

Postby expresso » 30 Jan 2021, 17:40

alot of Why's over here - no one has answers to - Why this or Why that or Why not this or that - save yourself the trouble and just do it yourself after - you will just get stressed and waste time talking to idiots anyway -
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Re: group 4 chairs

Postby swalker » 30 Jan 2021, 23:27

Burgerman wrote:I thought we had a messed up system!

Group 3 - The most capable PWC Medicare will typically fund. A wheelchair that is suitable for use inside a patient's residence. An example would be the Permobil F3
Group 4 - A more capable PWC, especially one capable of being used outside the patient's home. An example would be the Permobil F5

Whats the difference in those chairs? They look initially very similar. As far as rules? What decides?


The wheelchair groups have been identified by Medicare, a very large US bureaucracy that is very difficult to get answers from.

The only way I know to find out if a particular wheelchair is covered by Medicare is to submit the paperwork to Medicare and then wait for their answer. You can appeal their answer up several levels, but finding out what they will cover ahead of time has been impossible for me so far.

I have found several sources for the group 3 vs group 4 criteria. Medicare is not one of those sources. Based on the sources I have found, here are some things that cause a wheelchair to be group 3 vs group 4.

1. Group 3 wheelchairs are allowed a maximum speed of 4.5 (some sources say 5.0) MPH. They are only covered for indoor use, so high speed is not necessary
2. Group 3 wheelchairs often have very limited or no suspension system. They are only covered for indoor use, so do not need to be comfortable over rough terrain
3. Group 3 wheelchairs have smaller batteries. They are only covered for indoor use, so do not need much range.
4. Group 3 wheelchairs are less stable and can thus support more limited range of power actuator motions. They can have tilt, recline, and legs, but the range of those movements is somewhat limited
5. Group 3 wheelchairs do not need much ground clearance (not needed for indoor use)
6. Group 3 wheelchairs do not have lights (not needed for indoor use)

The Permobil can meet all the above criteria, so it is often judged to be a Group 3 wheelchair.

The Permobil F5 exceeds many of the Group 3 criteria. It can go up to 7.5 mph, has group 24 batteries, and has a nice suspension. The F5 also is much more stable than an F3, allowing it to have a greater range of actuator movements.

The bottom line is that I will never know what Medicare will cover until after they have reviewed my application, but submitting for an F5 is almost certain to be denied, unless there is some compelling medical need for an F5 feature that is not available on the F3.

In the US, anyone can get an F5 through Medicare if they are willing to pay out of pocket for the price difference between the F3 and the F5.

Steve
Permobil F5 Corpus 3G
Permobil C500s VS
Permobil C500 Corpus 3G
Permobil C350 Corpus 3G
Magic Mobility X4 with 176 Ah LiFePO4
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Re: group 4 chairs

Postby swalker » 30 Jan 2021, 23:32

expresso wrote:https://www.health.ny.gov/health_care/medicaid/program/update/2020/no18_2020-12.htm#dme

new rules - home and/or community. Please Note: New York State Medicaid funds and maintains one medically necessary manual mobility device to meet the member's medical needs whether primarily used in the home, community, or as a back-up to the primary Power Wheelchairs (PWC).


That seems to be limited to the state of New York. I have found some sources that indicate some aspects of that might be coming to Massachusetts as well. So far I have found nothing that would indicate it is coming to the whole US or to Colorado where I live. Too bad!

Steve
Permobil F5 Corpus 3G
Permobil C500s VS
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Permobil C350 Corpus 3G
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Re: group 4 chairs

Postby Gnomatic » 31 Jan 2021, 00:07

I got my Group 4 Magic Mobility V6 through one of my state's Managed Care companies, which administers Medicare/Medicaid services. The managed care company not only denied my application for the Group 4 chair, but also wrongly claimed I wasn't even eligible for a Group 3 chair. They were VERY wrong. They're a private company who doesn't like to approve things so they can keep as much of that Medicare/Medicaid money the government gives them to run those programs.

I had to go through appeals and be a pain in their ass. But they knew they were in the wrong and eventually gave me everything I asked for. Likely to make me go away as I was raising a stink. The problem is these companies know most users won't appeal or fight very hard, even if they are in the right.
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Re: group 4 chairs

Postby expresso » 31 Jan 2021, 00:20

i agree there Gnomatic - you were lucky also with the vendor who started your order to begin with - i would at least expect them to do it and let you have a chance to fight it but some wont even start the order

since the sunrise chair 636 is a group 3 - has shocks - strong frame - outdoor ready - and speed is standard at 6.5 mph - - PM would be the 90A version - JS plain led and can be either VR2 or Rnet - that would depend on the power functions you may need - if only tilt - then you get VR2 - if you need more than 2 or 3 power functions then you need the Rnet PM - can still be 90A version though and speed wont change and Gr 24 batteries for sure on a Group 3 chair - maybe the chairs you are looking at dont offter that size because they dont fit there chairs.

and thats still a group 3 indoor use chair - if you wanted to upgrade the PM to 120A - and get the larger color JS - - the speed etc, you can if you want to pay the difference - and its alot the cost - best bet is try to get it and fight it -

now some vendors may not even consider starting a group 4 chair at all if insurance is known not to cover it period like medicare - but thats changing here at least in NY - it should follow suit to every state i would think - medicare for me is the same medicare for everyone in the US ?

medicaid is the tricky one - where its a bit different state to state - its not federal like medicare -
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Re: group 4 chairs

Postby Gnomatic » 31 Jan 2021, 01:29

expresso wrote:i agree there Gnomatic - you were lucky also with the vendor who started your order to begin with - i would at least expect them to do it and let you have a chance to fight it but some wont even start the order


That' an excellent point, expresso. All my local vendors refused to try, even for the gimped Group 3 version of the V6, the C73.(if you order a Group 3 C73, with all the available upgrades, which I did, it literally turns it into a Group 4 V6) I was willing to pay out of pocket for all the upgrades to turn the C73 into a decked out V6, but no local vendors even wanted to try. So contacted the Director of Innovation In Motion, the US distributer of MM chairs, and asked them to find a vendor in my state who was willing to try. IIM eventually did find me a vendor, a little over 120mi away. But I was okay with that, as the vendor came to me. Then the insurance battle started ......
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Re: group 4 chairs

Postby expresso » 31 Jan 2021, 01:56

good job - it paid off - that was the same with me - my chair group 3 - and we added the features i needed and wanted - turns it into a group 4 after that -

its a good way to get it going and approved because its a group 3 to start - makes it a bit easier just to get it started and then fight it when denied - you have nothing to loose this way - if you do nothing you already lost -

if that ever happens to me - i will do the same - ask to find a vendor who will do it - and go use them - but i have plenty of time now on my next one - which i will demo the V6 for sure - what are the chances of anything new coming along from sunrise here with RWD - not betting on it -
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Re: group 4 chairs

Postby Fusiongoat » 31 Jan 2021, 07:41

I'm going to give my own experience and then respond to some of the other posts.
I have Medicare and Medicaid, but I only got Medicare in 2016 and they've never purchased a chair for me. Colorado Medicaid approved my Permobil F5 in 2015, but they didn't pay for most of it because I also had private insurance. Medicaid just is buying me the Bounder Plus 300 but this is kind of a gray area because it's not coded. It clearly is more than a Group 3 chair, however. Also, they paid for the lithium battery which is more than pretty much any other insurance would pay for. Numotion did not even submit it to Medicare. I was told that if a Group 4 chair is submitted to traditional Medicare it will be autodenied by a computer although you can still appeal.
Also, as for Medicare Part B vs. Medicare Advantage, Medicare Advantage plans can pay for anything they want beyond the Medicare rules, but this doesn't have much bearing on people who have Part A and B through traditional Medicare. That's why I just dumped traditional Medicare for Medicare Advantage. Also, I'm able to see which chairs I got back to 2005 and they were all Group 4.
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Re: group 4 chairs

Postby Fusiongoat » 31 Jan 2021, 07:51

As for the difference among Group 1, 2, 3 and 4 chairs, I will elucidate!
First, we do not care about Group 1 and 2 chairs because they all suck and most people who would be posting on this board would qualify for a Group 3 chair. In order to get a Group 3 chair you have to have a neurological or neuromuscular / skeletal condition and be unable to operate a manual chair, although I don't know exactly what that last part means. Anyway, a Group 3 chair has to meet the following criteria, although it's a bit confusing because it can exceed some of them:

"All Group 3 PWCs (K0848 – K0864) must have the specified components and meet the following requirements:

Standard integrated or remote proportional joystick
Non-expandable controller
Capable of upgrade to expandable controller
Capable of upgrade to alternative control devices
May not have cross brace construction
Accommodates seating and positioning items (e.g., seat and back cushions, headrests, lateral trunk supports, lateral hip supports, medial thigh supports) (except captains chairs)
Drive wheel suspension to reduce vibration
Length - less than or equal to 48 inches
Width - less than or equal to 34 inches
Minimum Top End Speed - 4.5 MPH
Minimum Range - 12 milesMinimum Obstacle Climb - 60 mm (Approx. 2 3/8")
Dynamic Stability Incline - 7.5 degrees"
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Re: group 4 chairs

Postby Fusiongoat » 31 Jan 2021, 07:55

As for Group 4 these have characteristics that are only necessary for community use. In reality this is a bit inconsistent because you can see that some of the characteristics of Group 3 chairs are not really necessary for use inside the house but the Medicare system is dishonest and these criteria are just designed to save the government money.
A Group 4 chair has the following characteristics:
• Standard integrated or remote proportional joystick
• Non-expandable controller
• Capable of upgrade to expandable controller
• Capable of upgrade to alternative control devices
• May not have cross brace construction
• Accommodates seating and positioning items (e.g., seat and back cushions, headrests, lateral trunk supports, lateral hip supports, medial thigh supports) (except captains chairs)
• Drive wheel suspension to reduce vibration
• Length - less than or equal to 48 inches
• Width - less than or equal to 34 inches
• Minimum Top End Speed - 6 MPH
• Minimum Range - 16 miles
• Minimum Obstacle Climb - 75 mm (Slightly less than 3")
• Dynamic Stability Incline - 9 degrees
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Re: group 4 chairs

Postby Fusiongoat » 31 Jan 2021, 08:18

swalker wrote:
expresso wrote:https://www.health.ny.gov/health_care/medicaid/program/update/2020/no18_2020-12.htm#dme

new rules - home and/or community. Please Note: New York State Medicaid funds and maintains one medically necessary manual mobility device to meet the member's medical needs whether primarily used in the home, community, or as a back-up to the primary Power Wheelchairs (PWC).


That seems to be limited to the state of New York. I have found some sources that indicate some aspects of that might be coming to Massachusetts as well. So far I have found nothing that would indicate it is coming to the whole US or to Colorado where I live. Too bad!

Steve


There is a lot of confusion about these issues because so many people have Medicare and Medicaid but also many people have one or the other. Colorado Medicaid standards for a Group 4 chair are basically the best in the country:
"A GROUP 4, NO POWER SEATING OPTION PWC IS COVERED IF:•The primary use is for ADLs or IADLs, which take place in Accommodated Environments; and for Extensive use in Non-Accommodated Environments, which include rough, varied, or uneven surfaces that are regularly encountered and that cannot be accommodated by a Group 3 PWC or other lower level PWC; and either•The client has an Impairment in Body Structures or Functions and requires an individually configured seating system; or•The client has a diagnosis, prognosis, or other symptomatology that will likely cause a change in the client's functional abilities over the lifetime of the chair, requiring modifications to the seating configuration, drive control method, or chair electronics."
https://www.colorado.gov/pacific/sites/ ... lchair.pdf " See p. 32
Now, I've heard hat sometimes people are denied unfairly and have to appeal but that's another issue. It hasn't happened to me. "Accommodated environments" are basically completely ADA compliant environments including terrain and slope, which is one foot of length for every inch of rise. Everything else is a nonaccommodated environment, for example, my driveway and my back yard are nonaccommodated environments.
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Re: group 4 chairs

Postby expresso » 31 Jan 2021, 17:25

its a big mess and confusing even for the experts - cant give you answers - it varies state by state with Medicaid -

with medicare again if you have the reg. Medicare - Part A and B - and then 2nd insurance Medicaid - which are all MLTC plans now - thats the tricky part also - depending on which MLTC plan you have - will affect the outcome - in my Case i have VNS Choice and they suck :fencing

they are the ones that just deny - deny deny - at the hearing they had nothing to say to the judge other than one stupid mistake on the paper work which was a joke - the courts knew it - during the hearing - in the end i had the final say to the judge - and he asked me specfic -

which chair is your primary chair - i told him - that was it - VNS was trying to say it wasnt my primary chair so they dont have to pay - it wasnt true and history shows who paid for that chair before - guess who - Medicare Medicaid - it as group 4 also - but i didnt have VNS choice insurance then -

comes down to the insurance - hopefully with new rules coming in effect for outdoor chairs to be allowed and billed for - this should slowly change - if not the courts would approve it in the end - just dont give up -

the bounder 300M is a group 3 and billable to medicare now- thats why they had to lower the speed down to 6 - and changed to Rnet etc, made a few little changes in order to qualify -

i got one of the last built bounders at top speed setup with there own electronics - works good for me - now if they had Rnet back then - would have been nice to try that - but i had better 2nd insurance then - no one had problems getting group 4 chairs if you had ICS insurance - in time they went under - so no more easy group 4 chairs now -

again it will change now with the new rules goin into effect -
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Re: group 4 chairs

Postby Burgerman » 31 Jan 2021, 17:35

czy
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Re: group 4 chairs

Postby expresso » 31 Jan 2021, 17:38

yes i agree and thats the face the experts make when they have no clue on anything either - not only with insurance -
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Re: group 4 chairs

Postby Burgerman » 31 Jan 2021, 17:52

I am afraid that the world it run by all those that were not bright enough to work for themselves, to create a job, to produce anything useful. They are mostly these types. They call themselves polititions. So the least capable running the country. Glorified parking attendent mentality without a clue.

Then theres the corrupt system, and mass effective monopolies in many areas, that you all seem to revel in in the US.With all kinds of market distortions and cronyism esp in medical stuff. Add to this that the average person on the planet isnt very bright to put it mildly. And that never ceases to surprise me over and over. And half the planet is by definition, even STUPIDER than average -- with an IQ around room temperature! And that leaves us where we are. Worse still, the more stupid they are the the less they seem to realise how little they actually know and these are your experts and jobsworths we deal with day after day.
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Re: group 4 chairs

Postby expresso » 31 Jan 2021, 18:06

sometimes the lower IQ call them what ever seem much happier in life than the so called smart ones -

sometimes more you know smarter you feel you are - kills you faster - and that low IQ lives on happy smiling enjoying life - :lol:
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Re: group 4 chairs

Postby Burgerman » 31 Jan 2021, 18:15

Homer simpson went to the doctor to see why he had headackes. Aparently he had a pencil hammered up his nose into his head by a bully as a child. It was making homer stupid. The doctor pulled it out. When he got home he found he could communicate with his daughter lisa and understand all about the world and its ills. He became depressed. Went back to the doctor to get the pencil put back in. And then he was happy and dumb all over again.
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Re: group 4 chairs

Postby expresso » 31 Jan 2021, 19:59

:thumbup:
Quickie 636 - 230ah LifePo4
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Re: group 4 chairs

Postby Rollin Positive » 31 Jan 2021, 20:00

Thank you all so much long story short version working with expresso who has an order in for a new chair and like many of you was discouraged on getting a group 4 configuration but guided to a group 3 chair with upgrades...

I think like others he believed the DME (wheelchair store) were the experts and so the sage continues.

Steve great job of listing the differences in 1, 2, 3 and group 4 chairs.

I think were you and others go wrong is thinking that its a rare occasion that group 4 get funded more then I think DME convivence customers it wont get funded so the orders don't get put in.

Rolling in a F3 and brand ambassador for Frontier and also ride a v6

Last year not traveling due to covid started really talking with people about this.

I was up for a new chair in Oct 2020...and for BM and others not in the US we become eligible every 5 years for a new chair

So 6 months out I knew I wanted a F5 group 4 because of its 7.5 motors.

I got the same story not only from my Permobil rep but also from the NuMotion rep that it cant be funded!

I sat them down and told them I had done my research and found people in Los Angles, Colorado, Phoenix, Ohio, New York and NJ that had group 4 chair and got them funded no problem with Medicare, Medicaid (Non US posters) that is our government paid insurance.

I was not going to take no for a answer and if they had to work harder so so need and documentation then so be it!

I also made them keep me posted on each step as it happen

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!

This why I am thinking its not rare they get approved I think due to this industry its rare they get submitted as group 4 chairs

Even with my approval I had a person at NuMotion Phoenix refuse to take my order to the next step because she wanted to argue group 4 chairs don't get approved and it was an error!

I called the Executive office of the President of Aetna and the had a representative of the President call NuMotion and tell them the chair was 100% approved even the seat elevation...

Needless to say that person at NuMotion has retired none to soon!

I have emails out to the Director of Medicare Liz Richter but 100% think I am right...

On your next chair demand it be a group 4 and don't settle for anything less!
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