How to Get an Electric Wheelchair or Scooter Through Insurance

Art: Robin Mead

GETTING MEDICAL EQUIPMENT

Many people who try applying for a Scooter or Electric Wheelchair get turned down by insurance, even if they really need it. Luckily, if you read this page, you can learn a some handy, good ideas to help you get the equipment you need.

WHY IS IT SO HARD?

Power scooters can be harder to get approved than other forms of medical equipment. Why is it harder? We don’t know, but it may have something to do with these Medicare Scooter Scandals a few years back.

Don’t worry. Many of our readers with ME, CFS, Lyme, POTS, and related conditions were able to get scooters covered by taking a few extra steps. It’s possible!

STEP ONE: LEARN THE MEDICAL CRITERIA

If you know the criteria to qualify, everything else will get a whole bunch easier! Every insurance company may be a little different, and different types of wheelchairs will have different requirements, but as a general rule this is the basic, main criteria for most insurance is the same.

Important. Please read. This is the number one reason our readers get turned down: Sample Insurance Criteria for Electric Wheelchairs and Scooters

STEP TWO: DECIDE IF YOU WANT TO APPLY

Once you have the wheelchair, you are allowed to use it both inside and outside the home. However, if you only need it for outdoor use, you will be denied.

🍃 Not sure if you qualify? Please read this before making a final decision: Do I Need a Wheelchair Inside My Home? (Pop Quiz!)

🍃 Sure that you don’t qualify? You might find this page helpful: How to Get Medical Equipment Without Insurance

🍃 Getting equipment through insurance is better because the equipment will be new, it will have a working battery, it may be the right size and type for you, and it may come with repairs and warranty. If insurance is not an option for you, in some areas you may be able to find an organization that donates or loans free equipment.

STEP THREE: GET ASSESSED

🍃 Next you need to get an assessment. This can be done by your regular nurse or doctor. Or by an occupational therapist or physical therapist. They may be able to perform the assessment in your home. How to Get an Assessment

🍃 One of our readers recommends Numotion. They provide assessments, equipment and help navigating insurance. Check if numotion is in your area.

🍃 If you want, you can do these steps slightly out of order.

STEP FOUR: FIND A MEDICAL SUPPLY COMPANY

🍃 You need to find a medical supply company to provide your chair or scooter. Be careful. Just because a medical supply company tells you that your insurance will reimburse you, that does not make it true!

🍃 If you’ve had an assessment with a physical or occupational therapist, they may already know a medical supply company in your area. If not: How to Find a Medical Supply Company

STEP FIVE: DECIDE WHAT YOU WANT

🍃  The person who does your assessment may be able to help you figure this out. Or you can do research on your own: How to Select a Wheelchair or Scooter

STEP SIX: COORDINATING

🍃 Now you need to get your doctor to send the written assessment to the medical supply company. Or you can get a copy of the report and send it yourself. Sounds simple doesn’t it? Doesn’t it always.

STEP SEVEN: HOME INSPECTION

🍃 This does not happen in all cases. In some cases, the medical supply company may be required to visit your home and make sure the wheelchair can be safely used inside your home. Learn more: How to Get a Home Inspection

STEP EIGHT: TA DAH!

🍃 Your wheelchair is all yours now. Medicaid and medicare should bill your insurance directly. For private insurance, you may need to get a pre-approval and then get reimbursed (get the pre-approval in writing before you get your chair!)

SAMPLE LETTERS 

🍃 Request for an electric wheelchair that reclines or tilts – sample doctor’s letter

🍃 Request for a manual wheelchair that reclines of tilts – sample doctor’s letter

🍃 Sample letters for a SmartDrive or Pushtracker – A small electric device that can be attached to the back of a lightweight folding wheelchair. Learn more about SmartDrive

🍃 Sample Letter for KD Portable Electric Wheelchair – For private insurance (not medicare or medicaid)

SUCCESS STORIES

🍃  Lupine Gets a KD Smart Chair Through Private Insurance

🍃 Lilac Gets a Mobility Scooter Through Medicare

🍃 Patricia Perez Gets a SmartDrive MX2 Through Medicare

SPECIAL NOTES FOR MEDICARE

🍃 Medicare has stricter rules than most insurance companies. For Medicare a face-to-face appointment for an assessment is required, and the Medicare Criteria must be written in the doctor’s chart notes, not a separate letter.

🍃 Your doctor does not have to be an MD. They can be a nurse practitioner, physician assistant, or clinical nurse specialist

🍃 If Medicare is your only insurance, you may be charged a co-pay for medical equipment. Check out: How to Escape Medicare Fees

LEARN MORE

🍃 If you are applying for disability, or already on disability, please make sure to get a copy of any forms or assessments your doctor fills out. These can be very helpful. How to Document Medical Equipment While Applying for Disability

🍃 Wheelchairs and Scooters are just one type of medical equipment. There are many other things that can also be helpful: How to Get Medical Equipment

🍃 If you have Myalgic Encephalomyelitis or Chronic Fatigue Syndrome: How Do I Know If I Need a Wheelchair?

🍃 If you feel that you won’t be able to qualify through insurance, you can pay out of pocket or you may find it helpful to see if there are any programs in your area that offer free medical equipment: How to Pay for Medical Equipment Without Insurance

What Do You Think? 

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