Here are a few good ways to help make sure your electric wheelchair or other medical equipment gets approved by your insurance company:
Option One: Find a physical or occupational therapist
An occupational therapist or physical therapist can perform an assessment for you. In some cases, they may also know the insurance requirements.
To get an assessment, try contacting physical therapists, occupational therapists, home care agencies and/or rehabilitation programs in your area. You can also contact your local Area Agency on Aging and ask for a referral – call them even if you are young. Or ask your doctor. Or a Google the words “wheelchair assessment” and the name of your city or area.
If you need a visit in your home, you may be able to find a physical or occupational therapist who can do a home visit. Try calling or emailing physical therapist in your area to ask who can do a home visit.
Any physical or occupational therapist can assist you, however if you find one who specializes in wheelchair or medical equipment assessments or who works at a rehabilitation program, they will know more about how to navigate insurance and how to get you special modification or customizations to meet your needs. These may be called a “seating specialist.”
If you are looking for a specialized are customized equipment, and your assessment is being done by a physical therapist who does not specialize in this, it may help if you find a copy of the insurance company policy and bring it to them.
Important note: In addition to having an assessment completed by a physical or occupational therapist, you may also be required to have a face-to-face evaluation with your primary care provider who can write the prescription. These rules vary depending on your insurance company. Here is an example of rules from Medicare.
Option Two: Get an Assessment by Your Regular Doctor
Any doctor or nurse can perform the assessment and order your medical equipment.
Unfortunately your doctor may not know the rules for your insurance company and many people get denied this way. What we are hearing from readers is that small equipment like walkers or manual wheelchairs are more likely to get approved, but power scooters and other more expensive equipment gets denied unless the doctor writes the exact correct thing in the records.
One solution to this is to find a medical supply company. A medical supply company may be able to send your doctor copies of the insurance regulations or special forms to fill out to help you qualify. Warning: Some medical supply companies will not bill your insurance but instead may tell you that your insurance company is going to reimburse your medical equipment. Never trust this unless you have written pre-approval from your insurance company. How to Find a Medical Supply Company
Another solution is to find the policy is yourself. If you can find out your insurance company’s policy for the equipment you want, you can bring it to your doctor and your doctor can write the correct things in your chart notes. Find a copy of your insurance company policy
Option Three: If You Have a Hospital Stay
If you have a stay in a hospital or clinic, before you get discharged, you can try requesting to meet with a hospital Social Worker. Ask the Social Worker if it is possible to get an evaluation for medical equipment, some hospitals have the capacity to do this.
WHAT DO YOU THINK?
🌷 This page is part of the free online guide: How to Get an Electric Wheelchair or Scooter Through Insurance, Art on this page by Robin Mead and Elizabeth D’Angelo. Page Updated: 7/1/19
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