Denial of Seat Elevator

[Brianna Albers]

I’ve had a seat elevator on every single one of my power chairs, but my primary insurance just denied it for my next chair. Thankfully, Medical Assistance agreed to cover it, but I’m curious. Have any of you struggled to get a seat elevator covered by insurance?

[Greg Sealey]

The first one (3 chairs ago), yes.  Insurance deemed it unnecessary for daily living.  But, my last 2 chairs with elevators were approved by insurance (one was private Insurance, the second was Medicare).

[Dennis Turner]

I was told it wouldn’t be covered and I needed to pay out of pocket for it four and a half years ago, but when I got the chair it had been covered. I can’t even imagine how difficult life would be without it for me.

[Alyssa Silva]

Last year, I was told that insurance would deny it because it was medically unnecessary (their words, definitely NOT mine). But if we appealed it they would then accept. That’s exactly what happened. Not sure why they created an added step and made more work for everyone involved, but it sounds about right when I think about advocating for my medical needs lol.

[DeAnn R]

Mine sailed through to my shock. Part of it is that I live alone. I also have a good team that know how to write a LMN.  Eventually I think it will become a standard feature but until then I guess we have to be ready to put up a fight.

[Kelly Miller]

I just ordered a new chair, and I was told insurance would not pay. Since it’s been denied every time on several  different brands and with several vendors in the past, we didn’t even try (I have Medicare as primary and private as secondary.) My guy at NuMotion suggested a foundation that I never would’ve tried b/c it’s not directly for SMA but focuses on ALS. It was a piece of cake! I had a 3-minute interview with a very nice and friendly woman who said she’d let me know in 1 day. She did, and I was approved just like that! I was amazed at the ease of it all.

I don’t know if I’m allowed to say the name of it here or not; maybe a moderator could let me know if that’s allowed. If so, I’d be happy to share!

[DeAnn R]

Kelly, you’re welcome to share if you’d like. Glad it worked out for you. I hate how many hoops some have to jump through for something that should come standard.

[Kelly Miller]

Thanks DeAnn.

 

I applied for a grant thru Team Gleason. Steve Gleason is an ex-football player for the New Orlean Saints who was diagnosed with ALS a few yrs ago. He started this foundation with some other NFL friends to help those with ALS to figure out the new world of disability for them. It talks about things like different aspects of wheelchairs, beds, computers, vans, and things like resources for the individuals and/or caregivers/spouses/family. The website explains about the grant regarding seat elevation and other features that really are “medically necessary” but won’t be covered by insurance.

They don’t specifically mentioned SMA, but that didn’t seem to be an issue. I’m guessing it’s b/c SMA is related. Once I was approved, (see post above), they sent the money straight to Quantum. I didn’t have to deal with the money at all.

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