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    What are your everyday thoughts, questions, concerns, successes, and challenges?  
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    83 Posts
    WHEELCHAIR DENIED
    By paris 85   
    My husband has been paraplegic for three years now; he uses a manual wheelchair purchased at the time. It is getting old; it has been repaired on several occasions. Not too long ago, he called me at work letting me know that one of his wheels was becoming loose; I rushed home to help him transfer to bed and avoided a fall.   

    For the past six months, my husband and I have been trying to get a manual wheelchair from his Medicare insurance company provider. We have been denied twice by them. It seems to me that a proper wheelchair is an unreasonable request. The insurance company offered a k003 wheelchair, which he returned immediately to them; the instructions indicated "do not use on ramps or operate alone. "There was no safety belt on this type of wheelchair either. It was simply not safe.

    I do not understand, perhaps I have been naïve thinking basic rights for the disable are protected. 

    Can any one give me some insight on this? We are on the second level of appeal something called MAXIMUS. It seems there are five possible levels of appeals offered by Medicare, if MAXIMUS aggress with the insurance company's decision. The next option would be to go to a judge. This seems insane. Do we have to wait for an accident to occur..

    It seems that the safety of the handicap is been overlooked and not taken into consideration in this situation.. 

    How sad..

    Can anyone guide us here? I am so mad.


     
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    Visit Judy's profile
    1 Posts
    Judy  says:
    Hi,  I am not sure what state you are living in, but below you will find a link to obtain the address and information for the nearest Consumer Assistance program regarding health care issues.  Some of these agencies will assist consumer's with insurance benefit appeals. 

    http://www.healthcare.gov/using-insurance/managing/consumer-help/index.html
    Posted:   
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    Visit Richard's profile
    10 Posts
    Richard  says:
    Hi Paris: I am a member of the Knights of Columbus. They have a program called Wheelchair Mission. Contact the niearest Knights of Columbus Council through the Catholic Church. They will refer you and you can then make a request for a wheelchair. During the Haiti earthquake, the Knighits supplied wheelchairs for people in need. I hope this will work well for you. These wheelchairs are free of charge.

    A Merry Christmas to you and your family, too.

    Richard.
    Posted:   
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    Visit zuzu's profile
    58 Posts
    zuzu  says:
    Great offer Richard.  I hope the Knights are able to supply Paris' husband a chair.  Paris, you may also want to contact your State's health insurance information program (or similar sounding name) that coordinates Medicare benefits with supplemental programs, as well as helps with Medicare claims that are denied.  This is a free service and can be handled over the phone or in person.  Most states also have a website where people list medical equipment for sale at little or no cost they no longer need.  Type in your state and "medical equipment exchange" or http://www.infinitecdme.org/.

    There is also an organization called the Patient Advocate Foundation that gives help dealing with insurance providers when they deny claims as well as help with medical cost assistance - http://www.patientadvocate.org/.

    Getting equipment can be difficult, but never accept "no" as an answer.  Tell your story to everyone and you'll be surprised at the response.  Just like Richard above, you may have incredible luck and find an organization or person who will offer you what you need for free.  We were able to get an almost new wheelchair to fit my mother-in-law's needs from a DME company for only $200 when I called around seeking a smaller sized chair that wouldn't swallow up her small body, and one we could purchase for her use in a skilled nursing facility so we could control its use and repair.  They decided on their own to put one together for us from used parts, offer it at a rock bottom price, and sold it to us on a weekend so we'd have it ready for a Monday morning doctor appointment.  

    Never ever, ever, ever give up.  You are tougher than they are!  Go Paris!!!!
    Posted:   
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    Visit Tonja's profile
    1 Posts
    Tonja  says:
    Medicare has a specific coverage guideline on Wheelchairs depending what state you are in.  The criteria must be met or you get a denial.  If you let me know what state you are in, I can look these up for you.  Your DME may not have filled out the paperwork correctly or some other problem. 
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    Visit paris 85's profile
    83 Posts
    paris 85  says:
    Thank you everyone for your input and tips regarding assistance in obtaining a wheelchair. I apologize for not replying earlier but just after I posted this blog our daughter moved back home after a failed relationship  and our lives became more chaotic then usual.

    Between minding her emotional needs, moving all the equipment and medical supplies I had stored in her room, and getting use to the new routine including her dog not getting along with our cats. Well...it has been difficult to say the least.

    Tonja, we live in Florida. The Insurance Company and the DME have not been cooperative at all, we have made numerous calls and all we get are different answers. We provided all medical records to the insurance company  showing my husband to be paraplegic from the chest down with no voluntary movement. One hundred plus pages from all kind of doctor's evaluations and nerve testing results.  He has an HMO which manages his Medicare. What would be the criteria? Your input is greatly appreciated. 

    I just do not understand.

    I guess I will like to ask the members of this community. Did you have to buy your own wheelchair to actually  have one that allows you to be independent and self-sufficient? 

    Posted:   
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    Visit paris 85's profile
    83 Posts
    paris 85  says:
    Thank you everyone for your input and tips regarding assistance in obtaining a wheelchair. I apologize for not replying earlier but just after I posted this blog our daughter moved back home after a failed relationship  and our lives became more chaotic then usual.

    Between minding her emotional needs, moving all the equipment and medical supplies I had stored in her room, and getting use to the new routine including her dog not getting along with our cats. Well...it has been difficult to say the least.

    Tonja, we live in Florida. The Insurance Company and the DME have not been cooperative at all, we have made numerous calls and all we get are different answers. We provided all medical records to the insurance company  showing my husband to be paraplegic from the chest down with no voluntary movement. One hundred plus pages from all kind of doctor's evaluations and nerve testing results.  He has an HMO which manages his Medicare. What would be the criteria? Your input is greatly appreciated.

    I just do not understand.

    I guess I will like to ask the members of this community. Did you have to buy your own wheelchair to actually  have one that allows you to be independent and self-sufficient? 
    Posted:   
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    Visit karen777's profile
    61 Posts
    karen777  says:
    i'llay a prayer for you that it will all work out to your favor.
    Posted:   
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    Visit paris 85's profile
    83 Posts
    paris 85  says:
    Thank you Karen. It is so difficult to deal with all the issues related to the health and wellbeing of a person that is a disabled human being. I honestly, feel over whelm at times. Not so much for what we can control but, all that we can not.

     
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