Has anyone encounter the trial of trying to Medicare to pay for a Power Wheel Chair for your spouse? My Jim can walk but walks so slow and only with my prompting that we really need one. It takes him forever to go from one room to the next. It would have to be one that I could operate from the back. He is too heavy for me to push in the manual chair that I bought, I can't use it. I am wondering if they would approve such a chair for someone who cannot operate one by themself.
My Mom got one, however she had cancer, not AD. They are not at all easy to qualify for under Medicare. The chair was nearly $6,000, and Mom had to pay $1200 of it. She had to qualify based on her breathing status, having to use Oxygen which restricted the distance she could walk. The PT folks worked directly with the Medical supply company in our area. They did lots of tests for measuring physical ability. We joked that it would probably come after Mom no longer needed it. She passed away 4 days after it arrived. Mom had hoped that my Dad might be able to use it after she passed on. He has been wheelchair bound for almost a year before. But the doctor said NO WAY. So did the Alz Care Unit where Dad now lives. It was considered too dangerous for Dad to safely use it around others, as he may "forget" how to properly use it. Each case is different, but it could be extremely difficult to have a doctor authorize one for him, and even if he did, getting insurance or medicare to pay will be a whole separate battle.
New Realm, Thanks for the help. The points you make on operation are very valid, I am wondering though as caregiver if they would approve one that has to be operated from the back by the caregiver. I have seen this before. I am going to give it a try as far as Medicare, probably will not get far but you never know. I will keep everyone posted about it.
I'm new here,my husband was diagnosed in 2001 and has gradually declinrd since then.But the walking is a problem with him also,he moves r eal slow and won't look up.I had never thought of the power wheel chair. nelliejane
Nelliejane, I started the inquiry with the Power Chair Company, we will know one way or the other. My husband can walk also, but very slowly and I have to prompt him to walk. It is so hard. Most likely we will not qualify because my husband is to the stage where he would not be able to safely operate one but why not allow him one if the caregiver has to always assist and cannot push the manual one. I am unable to push the manual one due to health reasons myself.
Jane My husband would not be able to operate one either and he can't follow instructions,but you are right we do everything else why not operate a power chair for our invalid husbands.
Nelliejane, I talked with the representative and was told that if my husbands cognitive impairment prevents effective use of the power chair that he can be compensated by a family member such as me if I am consistently available in his home and willing and able to safely operate the chair. She said the caregiver's need to use the wheelchair to assist him is to be considered in the determination. Maybe my health problems will make him qualify. She said a manual wheel chair would be a possibility but I told her we have a manual chair and I am unable to push him in it due to my condition. She said they will also consider that. It will probably be a long drawn out thing but I am going to follow through. I will let you know.
The representative told me that the normal qualifications do not require a person to be unable to walk, just that they have limited mobility that prevents them from accomplishing daily living in a reasonable time frame. That will be us. They changed the laws in 2006, to make it more possible to qualify. Lets hope we can.
Well, we made the trip to the Doctor yesterday. Yes, he will give us the prescription, the paper work from the Wheel Chair Company was not there like it was suppose to be, they had not faxed it to him like they said they would. He said he will fill it out as soon as it arrives. He also told me that it will probably be a lot of back and forth with Medicare, that is usually how it goes but he will definitely approve it himself.
there is a web site called craigslist.org it is a buy or sale site for anything. I know that my area has the moterized wheelchairs for sale on there, and the prices vary from $400- $1200 or so. That is a lot better than new ones that you can't get coverage for. We bought one at a garage sale for my dad and it worked great . Not sure what you will find in the ones that you want to operate from the back. If the spouse was willing to accept one while they were capible of learning to drive one , maybe they might retain some driving ability later on.
Update on the Power Wheel Chair. Well folks, looks like we will not be approved for one. Our Doctor is on our side, the Medicare criteria will allow me to operate it, that is not the problem, the problem is that they do not accept the diagnosis. Alzheimer is not an accepted diagnosis for not being able to walk or really for anything. Medicare does not allow things for the Alzheimer patient, they are not worth it I guess. The fact that they have a degenerative brain disease is not good enough, they have to have things like COPD, heart disease, or osteo-Arthritis, it is not enough just to have the brain dying. Go figure. You will have to be a millionaire to afford the necessities for them unless you warehouse them off into a Nursing Home. We all should really contact our congress and have things changed.
My DH got a diagnosis of APRAXIA, MOTOR to qualify for physical therapy and a walker. Apraxia is "a neurological disorder characterized by the inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement Both the desire and the capacity to move are present but the person simply cannot execute the act" I just happened to notice the diagnosis on the referral that the neurologist gave to me to take to the physical therapist and looked it up on Web MD. Also, my DH has been told by the neurologist that he has lewy body dementia symptoms that are in her words not a part of "classical alzheimer's". Medicare paid for the walker and a bedside comode. Maybe your Dr. needs to add to the diagnosis of AD because of the problems with walking.
Jayne, You say maybe the Doctor should add the diagnosis of AD, Jayne that is what he says and that is what they say is not an accepted diagnosis for anything for Medicare and I do mean anything when it comes to medical equipment.
Does the APRAXIA, MOTOR fall under the Alzheimer also or is it just the Lewy body dementia. I know that Dementia only as a diagnosis qualifies for nothing also. Dementia is only a symptom and not a disease.
Jane I'm sorry this didn't work out for you. I was in hopes it would.just keep trying maybe a miracle will happen.It seems that when I get to my lowest point oops there comes a miracle. GOD BLESS
Maybe I said it wrong. I didn't mean ADD the diagnosis of AD. I meant put another condition (diagnosis) on the prescription that medicare accepts. Our Dr. must have known that a diagnosis of AD was not enough???? All I know is that I looked at the referral sheet for physical therapy and it did NOT say AD....it said APRAXIA, MOTOR. The neurologist used the words Lewy body dementia when I asked WHY he could not walk and his legs seemed rigid and sometimes seemed like they were frozen in place. That's when she said in addition to AD he had lewy body type symptoms. She said the same thing about the tremors and called it parkisonian type symptoms. The medical supply store that I go to did not ask any questions about the prescription for the walker or the prescription for the bedside comode. They are the ones that told me that Medicare would pay for them. However, Medicare would not pay for the lift chair (they sent the papers in for the part of the lift mechanism) but I have never got reimbursed for any of the chair. Medicare did not pay for the elevated seat for our regular toilet either. The medical supply store seems to know what Medicare will pay for and what they won't. All I really needed was a prescription from the Dr. I've been wondering about a hospital bed? Does anyone know what it takes to qualify for one?
My Dad has AD, lives in an Alz unit. He just got a hospital bed last week because he has reflux which causes him risk of aspiration pneumonia. Also, his belly is large and pushes on the diaphragm. That resulted in his lower lobes (lungs) not filling properly. In his case he had multiple needs for the bed, but the only requirement was that he had reflux putting him at risk for aspirating.
I didn't read this thread before because I wasn't interested in Power Chairs, but it isn't really about Power Chairs. It is really about how to get the things we need by getting the right diagnosis onto the prescriptions.
I have asthma. Last year my doctor got me a nebulizer. Most of the time I don't need it, but last year and again this month, I did. Just using my inhaler wasn't enough. I don't know what she wrote on the prescription, but I know she had to go through hoops to get me what I needed.
It is obvious from what has been written here that the medical supply houses know how to go through the hoops correctly. I think it is important that those of you who have succeeded in getting the medical supplies you needed share how you did that to the extent that you know what your doctor wrote down on those prescriptions.
My husband had additional blood tests ordered by the neurologist last year that have still not been paid for. The reason was that the reasons for the tests was not made clear. They were tests for things that his family practice doctor doesn't and never has tested for, since I've got great doctors here who share EVERYTHING with each other. Even blood tests have to have the right codes on them for them to be paid for.
It is my understanding from being part of the medical community that additional diagnoses are frequestly added to clarify what tests or appliances are needed. So the need for a wheelchair or mobility chair is not AD, because that is not really descriptive enough (although it should be, don't get me wrong here) but the doctor adding the qualified Apraxia, Motor, describes why the chair is needed. Qualifiers are really helpful to insurance companies, I believe. I think if we all encourage our doctors tro use more of them, the battle for resources for AD patients will improve. I think when the insurance adjuster gets a request, s/he has to have a reason for approving it. So if the reason is right there, no phone calls or followup needed, it might make it easier to pass it through. As a bonus, it will help illuminate what the disease does to people and their families, and the other needs that co-exist. Just my thoughts. Sorry to be so long.
Hello All, I just signed in to share this with all of you in case it may help someone in the future. As you will notice I am the one who first started this thread way back when.. In the meantime right in the middle of starting to fill out the paper work our Doctor had Emergency Surgery, and then my husband went on Hospice, so of course I had to stop the process, can't get durable Medical equipment while on Hospice, you have to take what Hospice offers and they do not offer power chairs.
Well, my husband was discharged from Hospice end of May, I immediately called a different place to inquire about the criteria as I knew we should qualify. I called the Physical Therapy end where they evaluate the need for the Power Chair after receiving a RX from the Doctor. The Physical Therapy dept told me that it is not the diagnosis that Medicare goes by it is the need and ability the patient has.
I then called our Doctor for another Prescription, which was sent to the Physical Therapy Evaluation Department. They made an appointment with my husband on June 10th 2009, evaluated him for the need and clearly saw the need for the chair. The fact that I have permanent nerve damage in my back that is well documented will allow a Upper Arm Control on the back of the chair (caregiver control) in order that I may operate the chair and assist my husband here in our home.
Got a call today from the Physical Therapy Department. The Wheel Chair is approved and will be delivered to our home next week for the final fitting. So I just wanted to share with you that it can be done if the need is there. I had to show his need and also the documented need for me that told them I am unable to push him in a manual wheel Chair.
Please celebrate this milestone with me. I hope this will help others.
Jane, I'm so happy for you! My husband just qualified for Hospice last night, so today they brought out the regular wheelchair, a walker with wheels, a bathtub chair and oxygen, in case he needs it. His newly assigned nurse came by this morning to give him a physical, and my daughter and grandson thought she was very good. As long as my grandson can push the wheelchair, we'll settle for the push kind. I'm glad you told us how to go about getting the power kind!
Jane, indeed that is excellent news! it makes life much easier when you get the equipment needed -in your case so glad you got the chair with controls. awesome! let us know how it works!divvi
Congratulations Jane...Somehow my dad got a power wheel chair before he passed away, and we still have it in reserve should the need ever arise...I also bought a Hercules lift for it, and we can lift into the Chrysler van and just go....I also managed to buy an oximeter, a oxygen generator, , and all types of medical equiipment. OT- if any one needs medical equipment, I often see these power chairs and other equipment for sale when a person passes away...Scooters and wheel chairs generally go from $100-700 and if anyone needs something, just email me and I will watch for it...
It makes our life so much easier to have the proper equipment. Congratulations Jane!! Lets celebrate. You did very well "navagating the system". The resources are there. Sometimes we don't know how to tap into them. Took my dh to the VA today to get measured for customized wheelchair. I originally was told by the social worker that it might take 4-6 weeks! Today, the therapist said maybe up to 4 weeks- sometimes sooner. Wow. I hope so. He is currently in a chair provided by the nh and it is too small. He is forever trying to reposition himself in it. Good luck Jane.
Jane, way to go! That's great news. So glad something is working out well for you. Please don't be a stranger here. You have been such an asset and have helped so many with your specialized knowledge.
Our experience has been that, with the correct documentation (dx indicating precise need, not necessarily "the disease" causing the precise need) the equipment can be gotten fairly easily. Working with one of the established equipment providers helps tremendousl;y, as they know exactly how to package the paperwork to expedite the process.
As for Power Chairs. Getting one with Caregiver controls makes good sense, especially if the LO is significantly larger than the caregiver, or the caregiver has physical issues of their own. However, there can be several drawbacks to getting one for the LO to drive themselves. One area already mentioned on this thread was the safety of others, if the LO's Driving skills are impaired. Another, and I speak from experience, is the fact that the larger power chairs can be Street Capable and have a range of 20 miles. Where I live, if a motorized conveyance is Street Capable, the Operator must be licensed. Relatives wanted to give one to my DH, who no longer had his license. I said, "No." They brought it behind my back and convinced him to 'keep it a secret'. I found out and there was a BIG TO DO. He was a solid stage 5 then and commenting "Where are we?" when riding the GoBus on routine trips. If your LO can no longer drive, driving a Power Chair is out too.
carosi, happened to my 87yr old dad, (RIP) they took his license and he got a hot rod scooter and the cops called my mom and told her they had dad pulled 'over' in his scooter on the highway going to town for a beer with his friend:)... they brought him home with his scooter in the squad car. divvi