Sister Needs Wheelchair Medicaid won't pay

[Cricket2]

For anyone out there who thinks the medical care in this country is fine, think again. Though things are better, yes I said better, after Obamacare was put in place, there still needs to be a lot of change.

I just found out that Medicaid and maybe Medicare will not cover my sister’s need for an electric chair. They say this is because she is going to use it in the community. What!!!

How else is she to get to the doctors, or go to the store? Are we expected to stick our sick and disabled in a closet so they can have a chair. I can barely push her in the one we have now due to my heart and muscular illness. She can’t push herself at all, and within two months will not be able to walk at all, according to doctors. (She can walk about 15 feet total now.) What in the Lord’s name is all this cruelty about?

ANY system that denies a disabled and sick person a wheel chair so they can access the community needs trashed. It is worthless and meaningless. We are supposed to live in a great nation. Well, think again. We might as well have Leper Colonies for sick here. What a joke.

 

[Bonnie]

I’m with you, Cricket. Medicare also doesn’t pay for vision or dental care. So when one is low-income, as we are, guess what doesn’t get done. We also have to pay for much of husband’s health care from our own depleted pockets. Medicare covers only part of it.

 

[Xantippe]

For anyone out there who thinks the medical care in this country is fine, think again. Though things are better, yes I said better, after Obamacare was put in place, there still needs to be a lot of change.

I just found out that Medicaid and maybe Medicare will not cover my sister’s need for an electric chair. They say this is because she is going to use it in the community. What!!!

How else is she to get to the doctors, or go to the store? Are we expected to stick our sick and disabled in a closet so they can have a chair. I can barely push her in the one we have now due to my heart and muscular illness. She can’t push herself at all, and within two months will not be able to walk at all, according to doctors. (She can walk about 15 feet total now.) What in the Lord’s name is all this cruelty about?

ANY system that denies a disabled and sick person a wheel chair so they can access the community needs trashed. It is worthless and meaningless. We are supposed to live in a great nation. Well, think again. We might as well have Leper Colonies for sick here. What a joke.

I understand you feel upset about this, and it is silly of them to deny her when it sounds like she’s going to qualify very soon, but what country or countries are you unfavorably comparing the US to? It’s my understanding that the motorized scooter for the disabled is very much a US thing.

Also, even in the US, the motorized scooter is a pretty new device. You see them on every grocery store outing now, but 15 or 20 years ago, I don’t think I’d ever seen even one.

Can you lean on her doctor a little harder to write a diagnosis that will yield a scooter sooner?

 

[pianistclare]

Call around to your local parishes.
I work in a parish and many well-intentioned people leave wheelchairs at our church. Apparently this is where chairs go to die. We have 5 of them. We seldom need more than one at a time at Mass for anyone who is feeling ill.
The parishes may have a stash, and may be EAGER to find a good home for one.

I hope it works out!
Clare

 

[QuestLove]

For anyone out there who thinks the medical care in this country is fine, think again. Though things are better, yes I said better, after Obamacare was put in place, there still needs to be a lot of change.

I just found out that Medicaid and maybe Medicare will not cover my sister’s need for an electric chair. They say this is because she is going to use it in the community. What!!!

How else is she to get to the doctors, or go to the store? Are we expected to stick our sick and disabled in a closet so they can have a chair. I can barely push her in the one we have now due to my heart and muscular illness. She can’t push herself at all, and within two months will not be able to walk at all, according to doctors. (She can walk about 15 feet total now.) What in the Lord’s name is all this cruelty about?

ANY system that denies a disabled and sick person a wheel chair so they can access the community needs trashed. It is worthless and meaningless. We are supposed to live in a great nation. Well, think again. We might as well have Leper Colonies for sick here. What a joke.

Maybe you can set up a kickstarter fund online. You have a genuine need and there are people who will be willing to donate.

 

[captainrick]

Call around to your local parishes.
I work in a parish and many well-intentioned people leave wheelchairs at our church. Apparently this is where chairs go to die. We have 5 of them. We seldom need more than one at a time at Mass for anyone who is feeling ill.
The parishes may have a stash, and may be EAGER to find a good home for one.

I hope it works out!
Clare

In my area, most first aid squads also keep donated wheelchairs, walkers, etc., to give to people who need them.

 

[WKW_69]

I just found out that Medicaid and maybe Medicare will not cover my sister’s need for an electric chair.

This whole sentence doesn’t make sense. If your sister is on Federal Medicare then Medicare is here primary provider. What does Medicare say? For a person on Medicare that is also on on State Medicaid medicaid may cover the 20% deductible for equipment and they may not. If State Medicaid won’t help pay for the electric wheel chair and Medicare will then the family and/or charity will have to raise the money for the 20% deductible.

medicare.gov/coverage/wheelchairs-and-power-mobility-devices.html

 

[Cricket2]

I understand you feel upset about this, and it is silly of them to deny her when it sounds like she’s going to qualify very soon, but what country or countries are you unfavorably comparing the US to? It’s my understanding that the motorized scooter for the disabled is very much a US thing.

Also, even in the US, the motorized scooter is a pretty new device. You see them on every grocery store outing now, but 15 or 20 years ago, I don’t think I’d ever seen even one.

Can you lean on her doctor a little harder to write a diagnosis that will yield a scooter sooner?

Motorized scooters where used plenty in Canada, well before they ever showed up here in the USA. My sister needs a wheel chair. A scooter will not serve her needs which are multiple. Wheelchairs are much more stable than scooters and certain medical conditions just are not compatible with using a scooter. Even if she could use a scooter she can’t afford it, and the price of wheel chair is worse. NO ONE should have to go without needed medical equipment due to the lack of funds. It is just wrong.

Whether people realize it or not the USA does not have the best medical care in the world and usually ranks in the lower half of the 50 developed nations. Place like Canada, Germany, France and Switzerland are usually in the top 5-10. One of the reasons the US falls behind is the cost, inability to get needed supplies, rate of errors, lack of keeping up with advances, and many other reasons. It costs plenty here, but we are not getting our money’s worth.

My cousin has to fight every time she needs a new wheel chair for her daughter who is quadraplegic. Every year, for nearly 30 years, she has had to prove that her daughter has not been cured of her disability. You would think all the world is trying to get a chair for the fun of it. There is nothing fun about having to use a wheel chair, so all the red-tape just floors me and is further proof that money is what they care about, not people. It is all about that stupid bottom line mentality.

 

[DeniseNY]

gammie.com/our-blog/115-why-is-it-so-hard-to-get-medicare-to-pay-for-a-power-wheelchair-or-scooter-when-the-tv-ad-makes-it-seem-so-easy

If she also needs it for inside the home, there is still a chance it can be approved (although it’s difficult). The link provides tips for how her situation should be presented to help in the process.

 

[maryjk]

My cousin has to fight every time she needs a new wheel chair for her daughter who is quadraplegic. Every year, for nearly 30 years, she has had to prove that her daughter has not been cured of her disability. **You would think all the world is trying to get a chair for the fun of it. ** There is nothing fun about having to use a wheel chair, so all the red-tape just floors me and is further proof that money is what they care about, not people. It is all about that stupid bottom line mentality.

No, they aren’t getting it for the fun of it. They try to get them to sell them. Or to use them to make money.

Yes, it happens. And yes, because there are people in the country that try to scam the government, people that are truly in need have to jump through extra hoops.

 

[white_sheep]

1% of everyone’s income goes to pay Medicare fraud.

 

[Xantippe]

My cousin has to fight every time she needs a new wheel chair for her daughter who is quadraplegic. Every year, for nearly 30 years, she has had to prove that her daughter has not been cured of her disability. You would think all the world is trying to get a chair for the fun of it. There is nothing fun about having to use a wheel chair, so all the red-tape just floors me and is further proof that money is what they care about, not people. It is all about that stupid bottom line mentality.

The US spends huge amounts of money on medicine–18% of GDP, the highest in the world. A huge chunk of that is government funded–Medicare, Medicaid, VA, whatever. Quite naturally, the feds are trying to figure out how to keep costs down. “Bend the cost curve down” is the administration’s terminology.

Presumably, as the government takes over more and more healthcare and as the population ages (pushing healthcare costs up even more and revenues down), we are going to be seeing more and more of the sort of situation you describe.

Also, the US federal government currently borrows 40 cents of every dollar spent (or it did just a few years ago), so there really is reason to be concerned about the “bottom line.” This can’t go on, and it won’t.

If I were a betting woman, I would bet on things getting considerably worse.

 

[Cat]

Ask the wheelchair company to go to bat for you with public aid (Medicare or Medicaid, whichever it is in your case).

They want to sell chairs. They will usually find a way to help their clients finance their chairs, or to get coverage for the chair from their insurance provider or public aid provider.

We see plenty of ads on TV about wheelchair and scooter companies who promise to “work with Medicare”.

Also, make DARN SURE that your sister’s doctor is “checking the right box” on the form. Many times, coverage is denied because the doctor checked the wrong box. Many doctors have gotten very savvy about which box to check to assure coverage. Just make sure–ask if the doctor’s office has an “Insurance Specialist” (most do nowadays–they have to, since government and private insurance is so complex). “Checking the right box” might make the difference when your sister petitions the government (Medicare or Medicaid, whichever) to cover the cost of her wheelchair.

The fact that Medicare and Medicaid (whichever it is) are not covering your sister’s needs is proof to me that the government has no business getting involved with the healthcare industry. We will see more of this type of rationing as the government gets more involved with healthcare.

And I agree with those who have posted urging you to bring your sister’s needs to local churches (if your own church doesn’t listen, go to other churches, including Protestant churches) and also to private organizations and individuals. If the need is as great as you say, you will find individuals and companies/churches who will be happy to help you out.

One more thing–it’s just possible that your sister’s request was denied by Medicare/Medicaid because they think she doesn’t need it. With great respect for your sister, I suggest that she determine whether they are right. It is always best if a person can continue to be mobile on their own rather than relying on a device. (I suffer from osteoarthritis, so I’m pretty cognizant of mobility issues). Probably the government is just trying to make sure that your sister isn’t giving up too soon. They’re probably wrong, but just make sure. If exercise or weight loss would help your sister remain mobile with less “machinery”, then perhaps she could work on that. But again, I’m pretty certain that in your sister’s case, the government is wrong about her capability of being mobile.

 

[ringil]

For anyone out there who thinks the medical care in this country is fine, think again. Though things are better, yes I said better, after Obamacare was put in place, there still needs to be a lot of change.

I just found out that Medicaid and maybe Medicare will not cover my sister’s need for an electric chair. They say this is because she is going to use it in the community. What!!!

How else is she to get to the doctors, or go to the store? Are we expected to stick our sick and disabled in a closet so they can have a chair. I can barely push her in the one we have now due to my heart and muscular illness. She can’t push herself at all, and within two months will not be able to walk at all, according to doctors. (She can walk about 15 feet total now.) What in the Lord’s name is all this cruelty about?

ANY system that denies a disabled and sick person a wheel chair so they can access the community needs trashed. It is worthless and meaningless. We are supposed to live in a great nation. Well, think again. We might as well have Leper Colonies for sick here. What a joke.

She must have a case worker through Medicaid. Call them directly. I am sure there is an appeals process.

In addition, anyone on Medicaid is eligible for Medicare transport- to bring her to and from appt.

I totally agree with you regarding the sad state of healthcare in the US- just trying to be helpful as I am a Social Worker who deals with this stuff.

 

[PaulinVA]

The fact that Medicare and Medicaid (whichever it is) are not covering your sister’s needs is proof to me that the government has no business getting involved with the healthcare industry. We will see more of this type of rationing as the government gets more involved with healthcare.

I usually agree with you, but I find this comment perplexing. We are talking about the public’s money. Our tax money. Are you saying that the government should not decide how our tax money is spent? If not “the government”, than who should make the decisions?

 

[Cat]

I usually agree with you, but I find this comment perplexing. We are talking about the public’s money. Our tax money. Are you saying that the government should not decide how our tax money is spent? If not “the government”, than who should make the decisions?

When it comes to healthcare, decisions about patient care (e.g., need for a wheelchair) should be made by doctors, nurses, physical therapists, and other direct caregivers, NOT by some politician/lawyer who doesn’t have a clue what’s going on in medicine and how it relates to any given patient.

Also, these decisions need to be made locally, as close to the patient as possible, not by an office in Washington, D.C.

 

[PaulinVA]

When it comes to healthcare, decisions about patient care (e.g., need for a wheelchair) should be made by doctors, nurses, physical therapists, and other direct caregivers, NOT by some politician/lawyer who doesn’t have a clue what’s going on in medicine and how it relates to any given patient.

Also, these decisions need to be made locally, as close to the patient as possible, not by an office in Washington, D.C.

But the decisions are still going to be “evidence-based” and follow rules created by the government (HHS/CMS), so what’s the difference? It’s an interesting discussion. The public (medicaid) does not have an unlimited source of funding (taxes) so someone has to manage the whole pot. Individual doctors aren’t aware of the larger issues.

You have two options here. Are the rules being applied correctly, and, if they are, should they be changed. Where should the money be taken from?

 

[Cricket2]

But the decisions are still going to be “evidence-based” and follow rules created by the government (HHS/CMS), so what’s the difference? It’s an interesting discussion. The public (medicaid) does not have an unlimited source of funding (taxes) so someone has to manage the whole pot. Individual doctors aren’t aware of the larger issues.

You have two options here. Are the rules being applied correctly, and, if they are, should they be changed. Where should the money be taken from?

I have to agree with “Cat.” Most doctors are not going to tell someone they need a wheel chair or any other equipment for the fun of it. Most people are not going to seek getting one for the fun of it. Medicaid and Medicare are out of line and so are the insurance companies. I am sick of rules and if you have enough members of your family who are ill and who need medicine and equipment and constantly have to fight for it you will start to realize how useless most of those rules are.

But on the brighter side, just by chance I went to meet with our new pastor about starting a garden at the parish next year. He had been praying for my brother and sister and asked how they where. I told him how my sister was denied her wheel chair…Well, someone just gave him one, an electric chair and he gave it to me for my sister. Thank God. I started to cry for joy and in disbelief.

We are grateful, for sure, but no one should have to go without care or treatment because selfish people want to control the money all the time. If there is a good example of “legalized thievery” in this country all one need to is check out medicaid, medicare and insurance companies (all of them). They do little but make millions for a few people on top.

 

[Cricket2]

I posted this in a reply to another poster, but just for everyone else: I went to visit our new pastor and by chance mentioned my sister not getting her wheel chair due to the fact they denied it. (You know, the “you don’t qualify” because we don’t want to spend the money stuff.) Anyway: someone had just given him a wheelchair and he gave it to me for my sister. It is a really nice, electric chair. I started to cry out of joy. Wow! Thanks for your prayers and give thanks to God.

 

[pianistclare]

I posted this in a reply to another poster, but just for everyone else: I went to visit our new pastor and by chance mentioned my sister not getting her wheel chair due to the fact they denied it. (You know, the “you don’t qualify” because we don’t want to spend the money stuff.) Anyway: someone had just given him a wheelchair and he gave it to me for my sister. It is a really nice, electric chair. I started to cry out of joy. Wow! Thanks for your prayers and give thanks to God.

Yup. Church is always the first place I look to for help.
Glad it worked.