Saturday, May 31, 2008

New Mobility illuminates growing problem of obtaining wheelchair reimbursement

Due to changes with Medicare and Medicaid, New Mobility reports in its June issue that U.S. wheelchair users will find that getting the durable medical equipment (DME) they need will be slower, harder and costlier.

"Restrictive documentation policies as well as outdated 'in-the-home' language that governs claims decisions in the Centers for Medicare and Medicaid Services (CMS) are creating hassles for DME dealers and consumers," according to New Mobility. "What's worse, power wheelchair reimbursements made by Medicare — already reduced by 27 percent in January 2007, will be reduced by another 19 percent on July 1 due to Medicare's national competitive bidding program. Since private insurance companies follow CMS' lead, these new policies portend a growing nightmare of denials, delays, red tape, and economic hardship for DME dealers and end users alike."

The story gives the example of Abbie Freedman of Santa Rosa, Calif., who has used a wheelchair for 22 years due a T5 spinal cord injury at age 39. Medicare has covered any new wheelchair she has needed -- until now.

Now in her 60s, her shoulders have deteriorated and her doctor recommended she get a power wheelchair rather than have surgery that would be a difficult recovery. Her doctor prescribed specialized physical therapy and the power wheelchair. She ordered the wheelchair and was told by the manufacturer that Medicare would cover it.

"Anxious to get on with saving her shoulders, she paid for it out of her own pocket, then filed a claim for reimbursement with Medicare," New Mobility writes. "She received the chair in September 2004 but was surprised when her claim for reimbursement was denied."

"I'm not sure I would have ordered it had I known Medicare wouldn't pay," she says. "$6,320 is a lot of money."

Freedman has been trying for four years to get the wheelchair reimbursed, with no luck.

"After nearly four years, they sent me back to square one," she said of the original claim form that she was asked to fill out again four years later. "The system is a joke, but it's not funny."