Does Health Insurance Cover Wheelchairs?

The question of whether or not health insurance covers purchase of wheelchairs is a timely discussion especially in the face of various healthcare reform agenda being forward in Congress and the Senate. With the rising costs of healthcare, not to mention the ever-sophisticated evolution in the wheelchair design from the once standard stainless steel manually-powered construction to the now motorized wheelchair, one would significantly benefit from a PPI claims like treatment of wheelchair in healthcare.

But alas, this is not the case. The truth is that current Medicare does not cover wheelchair purchases fully. In a few exempt cases, Medicare will pay for up to 80% of the wheelchair purchase cost. Consequently, there are avenues that would empower one to have a wheelchair shouldered by an insurance policy directly or indirectly. Like level term life insurance, these also carry preconditions and a thorough assessment has to be made as to whether the cost and practicality of the policy outweighs subsequent obligations for premium contributions and other relevant payments.

So let us first talk about Medicare, which is what many Americans rely on for their medical needs. The overriding condition required my Medicare for covering wheelchair purchases is for doctors to issue a certification that the wheelchair is essential to address a medical condition. Like you would with Masters in Accounting or Degree in Communications, this precondition is strict and will have to be complied with on all levels. Failure to do so would compel Medicare to reject the request for wheelchair purchase coverage.

When approved, the payment will only be made for up to 80% of the purchase consistent with Part B deductible limits. In essence, you can never expect Medicare to cover 100% of the costs so you get to spend the remaining 20% on a South Africa accommodation or check into flats to rent in Cape Town.

In some cases, it comes down to an argument about whether a wheelchair is indeed necessary. Doctors rely on a few basic rules to judge whether they should recommend a wheelchair or not. While these may seem basic and will not require an executive MBA program certification or an online MBA degree to be understood, it bears mentioning that doctors have the final say in recommending the coverage for wheelchairs.

A wheelchair should not be solely recommended in order to help someone move around. There should be activities that are essential to the patient’s way of life that will be addressed by using a wheelchair. In this regard, doctors can argue for events like bathing, dressing up, or going to the bathroom as examples of lifestyle activities that will be addressed with a wheelchair.
The size of the wheelchair will have to be proportioned to the size of your home. Requests involving big motorized wheelchair for a small home will likely be denied.
The patient has the full capability to operate the preferred equipment.

Getting support and coverage by health insurance policies on buying a wheelchair is like having to unlock HTC phones in that it may seem easy but it is not an outright given. Make sure to present a convincing and valid case when requesting for wheelchair coverage in order to save yourself time in lobbying for a shared payment scheme when it comes to wheelchairs.

19. March 2012 by Jay Brown
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