Lilac Gets a Mobility Scooter

Elizabeth D’Angelo

Lilac has severe ME, Chronic Fatigue Syndrome and POTS, which makes walking difficulty. She was able to get a mobility scooter through her insurance.

Lilac wanted to share her story to help others. Lilac has Medicare, but you may find her story helpful, even if you have a different type of insurance.

LILAC GETS A SCOOTER

When I needed a mobility scooter through Medicare, my doctor told me that all his other patients had been turned down and I should not get my hopes up.

I told him, “Don’t worry. I am very persistent! If I am turned down, I will keep appealing.”

In the end, it turned out I did not need to file even one appeal. I was able to get a scooter in my home and did not get charged anything.

MEDICAL CRITERIA

The most important thing you need to know is the medical criteria to qualify.

All of this must be noted in the doctor’s records:
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* You need this equipment inside your home (if you want to use it outdoors too you can – some models of scooter come apart and can fit in a car).

* You need this to get between bathroom, kitchen and sleeping space (at least some of the time)

* You need this to help with daily living activities (eating, bathing, bathroom)

* There needs to be a reason that other equipment is not good enough (walker, cane, manual wheelchair)

* You can safely operate it on your own and you can get in and out of it safely

* If you need special features, such as a reclining chair, there are even more criteria.

GETTING STARTED

In my case, asking my doctor how to get a mobility scooter was a total dead end. The doctor’s office gave me the names of several supply companies and when I called them none of them even took my insurance.

My experience in this area has been: if you need medical equipment, home aides, disability benefits, or other kind of help, never ask your doctor. Your doctor may be great at medical treatment, but she probably doesn’t know very much about applying for services. If you ask your doctor, she may tell you it’s not possible, or give you the wrong information.

Find out everything yourself, and then bring your doctor the forms to sign.

ASSESSMENT

To get a mobility scooter through Medicare, you will need to get an in-person assessment. You can do this through your doctor or through a physical or occupational therapist.

Here’s how to get an assessment: How to Get an Electric Wheelchair or Scooter Through Insurance

If you don’t have insurance, check out: How to Pay for Medical Equipment Without Insurance

For my assessment, I was lucky to find a good medical supply company who knew all the policies, and sent the forms to my doctor to fill out. I have a friend who did it a different way: she went for an assessment with a physical therapist who already knew all the policies and what to write.

Medicare requires a copy of the doctor’s records from the assessment. Unlike other insurance companies, they will not accept if your doctor just writes them a letter. There needs to be a medical record from the assessment and it needs to include all the specific info they are looking for. If your doctor has already done the assessment and left out anything important, they are allowed to go back and add an amendment.

MEDICAL SUPPLY COMPANY

You will also need to find a medical supply company that takes your insurance. For some insurance companies, you need to get the purchase pre-authorized. The medical supply company I used billed Medicare directly and I didn’t need to get anything pre-authorized.

There is an online list of Medicare Medical Supply Companies that you can search by area and type of equipment.

Medicaid also has online supplier directories. Each state has it’s own directory. You can check your state’s Medicaid website, or call and ask. Both the Medicaid and Medicare directories are not completely accurate and do not include all suppliers who are eligible.

When you get to the directory look for “Durable Medical Equipment.” This is what they call any kind of big medical equipment. If you want a scooter, do not search “scooter” they are called “power operated vehicles”

The medical supplier I used had specific forms and criteria for your doctor or for whoever does the assessment. This is the supplier I used. They appear to be available in all areas, but that does not mean the won the bid to supply Medicare scooters in all areas, so please check.

After the assessment, you or your doctor needs to submit the request to a medical supply company. The request needs to be sent in within 45 days.

MEDICARE BILLING

Some medical supply companies don’t know the insurance criteria and will simply try to get you to buy a scooter or sign a contract. Many companies will also make false promises to you, saying that insurance will reimburse you, and then it turns out not to be true.

Try to find a medical supply company that bills Medicare directly. In some areas this is called, “accepts medicare assignment.” In some areas it is the supplier who “won the medicare bid” to supply this equipment in your area.

If you have medicaid, the equipment is free. If you have a different type of secondary insurance, it depends what that policy covers. If you have just Medicare, you pay 20%, and Medicare pays 80%. (note: if you are in this situation, please see How to Escape Medicare Fees)

I have read to be careful before signing any contracts. I was never asked to sign a contract. After the scooter was delivered and in my house, I signed papers that it had been received and confirming how I would use the scooter.

HOME VISIT

The medical supplier will deliver it. In your house they will verify:

* The equipment can move between kitchen, bathroom and sleep space (If you sleep in the living room, that is allowed, but if you sleep in a space up a flight of stairs, this won’t qualify).

* You can safely operate the equipment

TA DAH!

That’s it!

I love my scooter, but I regret getting a four wheel. I thought it would be more stable, but since then I have tried a three wheel and they are very stable. Three wheel is much easier to maneuver.

I really wish I could have gotten an electric wheelchair instead, but I do not have a van. A scooter can come apart to fit in a car. Trying to get a van will be my next goal!

I believe my doctor when he said all his other patients had been turned down.

In my area, there is only ONE supplier that won the Medicare bid to supply mobility scooters. The delivery person had NEVER delivered a scooter before.

(Before he came to my house, he had to watch a training video on how to put it together).

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Updated April 2018. Please comment below with stories, ideas, questions or suggestions. Please let us know if any links on this page stop working. If you found this page helpful, please share it with others by pressing one of these magic little buttons: