Whether you’re purchasing a new wheelchair for the first time or replacing an older one, one question likely looms large: will my insurance cover this?
Most privatized health insurance providers do cover some portion of the cost of durable medical equipment, including manual wheelchairs, power wheelchairs, and power scooters. These providers, too, are often following practices outlined by Medicare.
Like any medical expense, the extent to which you’re covered will vary based on your personal plan. In addition to these variables, certain other factors may also affect the amount you’ll owe, like whether you’re buying or renting, whether your provider is within your healthcare network, and where you get your chair.
So, what do these insurance providers require when processing your insurance claim for your wheelchair?
The biggest piece of information you’ll need to provide for insurance reimbursement is your specific prescription. If your wheelchair is not prescribed, your claim may seem recreational or unnecessary and can risk being denied.
When submitting for coverage, keep in mind that if you have already been using a wheelchair and are seeking reimbursement for a replacement, you’ll need to prove that your old chair has outlasted its Reasonable Useful Lifetime. Medicare currently establishes a wheelchair’s RUL as five years; it’s likely that a claim made before the five-year period elapses will be denied, unless your health or mobility have changed significantly enough to require new equipment.
Invoice or Receipt
In addition to including your prescription, you’ll need to submit an invoice or receipt for the cost of the wheelchair, as well as your own medical history and physical, which you can acquire from the prescribing physician.
Your specific benefits package will also likely have an information or reimbursement form that you or your doctor will need to complete and submit for coverage. Your insurance provider will review your forms alongside state or local coverage determinations and will make their own coverage determination from there.
If you are covered through Medicare, your physician, occupational therapist, or equipment supplier will submit most of these documents for you.
Be sure to communicate openly with your doctor or occupational therapist about in-network suppliers and the best options at your disposal to live a more comfortable life without compromising financial stability.