What could possibly go wrong with a wheelchair order? Learn how to avoid the pitfalls

In parts 1 & 2 of this series, you learned about who you need on your team and what the steps are to acquire a new wheelchair. In part 3, you’ll learn about common pitfalls, false-starts and wrong turns and how to avoid them - or at least how to spot them early and right the ship. You’ll also read about repairing and modifying your wheelchair.  

I mean really, what could possibly go wrong?

You may have heard horror stories or had your own experiences when a wheelchair order goes south. Some orders take forever or seem to evaporate into thin air. Weird or unpleasant customer service experiences such as the consumer who experienced gaslighting when their wheelchair went into the shop and came back out as a completely different wheelchair. (“I’m telling you, this is NOT my chair!”), or the saga of a newly-built Group 3 power wheelchair languishing inside of a shuttered and locked DME-vendor, never to see the light of day, while the consumer waited for months for it to be delivered. Problems like these are rare, dear reader, but not unheard of. More commonly, consumers experience the problem of insurance denying payment for your new wheelchair, or the problem of taking possession of a wheelchair that doesn’t fit properly or function the way you need it to. 

What do you do if your insurance denies coverage of your new wheelchair, or for certain features of a wheelchair? 

You have to find out WHY the authorization was denied. 

• If authorization is denied because your insurance deems the equipment to be not medically necessary, then the problem is with the documentation by your healthcare provider during the face to face mobility examination

• If authorization is denied because of missing documentation, then either the healthcare provider or the seating specialist or both didn’t send in or sign (and date!) the needed chart note or other order element.

• Appeal the denial by contacting your insurance and asking how to appeal. You will usually need the support of your healthcare provider to submit an appeal. 

• Always make sure you know the best way to reach your healthcare provider, your mobility and seating specialist and your DME vendor, in case you need their assistance with an appeal

Ready for your close up

Working with an experienced team of healthcare professionals who understand the process and the importance of accurate documentation and submission of records cannot be overemphasized here. One good thing that came about during the COVID 19 pandemic is that face-to-face mobility evaluations can now legally be done via video visit. This means you can have a visit via video with an experienced or specialized healthcare provider like a physiatrist, even if their clinic is far away from where you live, as long as that person is contracted with your insurance. Your primary care doctor may need to request an authorization from your insurance to see a specialized provider like a physiatrist. 

The goods!

Once your wheelchair is authorized and built, it’s time to take possession of your new ride. I recommend having your new wheelchair delivered to the clinic or office of the wheelchair seating specialist during a scheduled visit. That way, the mobility specialist who measured you and documented the need for all the features, such as the seat cushion, the backrest, the foot rests and the anti-tip bars, can check everything out before you sign on the dotted line and accept the chair. This is a safer choice than accepting a wheelchair and then trying to return it later because it isn’t right. 

Maintaining your wheelchair

Over the life of your wheelchair, you’ll need to make repairs and modifications. The DME-vendor is usually ok with a direct call from you about a needed change or repair, and they can contact the healthcare provider of record for a written order for repairs or modifications if they need to. If you move from one state or region to another, you may have difficulty finding a DME vendor to work on your wheelchair. For this reason, a national DME vendor with offices in many regions might be a good choice. 

Did you know?

Insurance frowns on paying for repairs for wheelchair components that have been repaired by a layperson, such as a family member or a friend, so think twice before you do home repairs or modifications of your primary or most valuable wheelchair. 

• Balding tires, shaking castors, batteries that don’t hold a charge- all are common problems you will encounter from time to time.

• You can find some great donated wheelchairs to use as a back-up if your main wheelchair ends up in the shop. Check out a local organization that showcases donated medical equipment.to see if they can provide back-up chair. ReCARES in Oakland, San Francisco and Marin is a good place to start.

Where do you see yourself in 5 years?

Medicare guidelines stipulate you can order a new wheelchair about every 5 years, or sooner if there has been a new diagnosis or progression of disease which changes how you sit or what you are able to do.  An example of this might be progression of scoliosis, or if you have a spinal cord injury and subsequently are diagnosed with multiple sclerosis. You may also get a new wheelchair sooner than 5 years if your body changes such that you no longer fit or are able to sit healthfully in your seat. 

In five years’ time, you’ll be a little older and a little wiser. With perseverance, good record-keeping skills and strong partnership from your rehab team of healthcare professionals (who are themselves a little older and wiser), you’ll do this process all over again. I wish you success in getting the wheelchair you need, to be comfortable and healthy, and which enables you to do what you want to do, in your home and in the beautiful world. 

Rebecca Hummel-Moore, MSN, NP-C is a nurse practitioner and Advisory Board member for NorCal SCI. She practices in Berkeley, CA and has 12+ years working with people with SCI/D in both inpatient and outpatient settings.