When it comes to trying to obtain a specific answer to a Medicare (or other insurer) question, it
can be a lot like dealing with the IRS: ask three people the same question, and you'll get three different,
I've recently encountered this indecisiveness insurer-wide in trying to establish
a proactive protocol that complex rehab technology consumers can rely upon should they ever need to switch
service providers mid-stream (which is increasingly common based on providers cutting service or closing
based on funding changes). But, alas, I've established a consensus, helping form a protocol that all
using insurer funding to get a new complex rehab wheelchair should follow just in case switching providers
is ever needed.
Using Medicare as the flagship example (and Medicaids and most
other insurers follow Medicare's policies and procedures to some extent), there's a paper trail required
and formed in qualifying to have a complex rehab wheelchair funded as new, and ultimately serviced over
the long term:
1. Face-to-Face physical exam and diagnosis by a physician specific to needing
a mobility device
2. Specialty Evaluation (can be done by the physician if he or she knows complex
rehab technology, or, if not, then it's accomplished by a physical or occupational therapist)
7 Element Order (Beneficiary's name; description of item that is ordered, i.e., "power wheelchair," or
more specific; date of completion of the face-to-face examination; pertinent diagnoses/conditions that
relate to the need for the wheelchair; length of need; and the physician's signature and date)
An Assistive Technology Practitioner (ATP) works with the consumer to configure and specify exact technologies
5. Home Assessment is performed (which can technically be done at any point, including time of delivery,
to ensure wheelchair compatibility with one's home environment)
6. Detailed Product Description
(the literal line-item wheelchair order) is sent to the physician for signature, then returned to the
7. Delivery and signed acceptance of the wheelchair by the consumer
requires providers to have all of the proceeding on file for both the purchase and ongoing servicing
of the wheelchair.
Here's the Catch
In the event that you need or wish to switch service
providers after you own your complex rehab power chair, Medicare requires the new provider to have all
of the original paperwork on file. Unfortunately, most previous providers won't hand over the file because
it cost them time and money to originally compile (and they're sometimes peeved that you're switching
providers). From the new provider's side, he or she will often say, "I didn't sell you your chair, and
don't have any documentation, so I can't service it," (or, more succinctly, he or she can't get paid
to service it). Technically, a new provider could work with you to go through the entire documentation
process all over again to create the file. However, based on the time and expense, many won't because
it's a financial loss with little profitability in most repairs and service. As a consumer, you're then
Taking Proactive Control
In speaking with funding experts, Medicare, and providers,
all agree that while there's no 100 percent surefire solution to switching providers, having a copy of
your original file puts you way ahead of the game.
To begin with, throughout the original purchase
process, you should be in control. Help guide your physician in fully documenting your needs, and do
your research to work with the ATP to select the complex rehab technologies that best meet your needs
and wishes. However, here's the additional component to the process that every consumer should follow:
keep a copy of all documentation from the Face-to-Face onward.
Think for a moment how having a
copy of all original documentation eliminates the challenges of switching providers. As a provider told
me, "If a Medicare beneficiary came to me for a repair, and handed me a virtually complete documentation
file, I'd probably begin working on that chair immediately because I have just about all I need to submit
And, proactively compiling the file isn't hard to do. When you have the Face-to-Face,
get a copy of the physician's report. When you go through the Specialty Evaluation, get a copy of it.
Literally, get a copy of each document as you go, add it to a folder, and when you're done, tuck it away.
It's really that simple. Then, should you need to switch providers, BAM!, you've got the needed documentation.
Of course, creating your file is easy during the new wheelchair process,
as you can easily obtain copies as you go. However, what if your power chair is, say, two years old,
you have no documentation, and want to switch providers?
Firstly, you can very politely ask your
existing provider to give you a copy of your documentation from the original funding process. If you
play it cool, and have a good relationship, he or she may give you a copy. But, if you demand it because
you're switching providers, he or she will likely refuse. Ticking off a provider won't get you your file.
Secondly, again, the new service provider and you can go through the whole documentation process
all over, but most providers won't based on the time and expense involved toward a low-profit service
Lastly, you can try retracing the process to piece the paper work together. Get a copy of
the Face-to-Face from your physician's office, get a copy of the Specialty Evaluation from your therapist,
and so on.
None of these are the most practical route, as the documents should truly be compiled
during the original process, proactively. However, for many who already own a complex rehab mobility
product, a combination of these three strategies can help get documentation in order.
When Alliance Seating and Mobility abruptly closed its doors, it left its consumers in the
exact situation we're discussing: consumers needed service by new providers, but struggled to obtain
it because they had no access to the needed original documentation. If an Alliance consumer had followed
the techniques discussed here - simply keeping a copy of each document in the process - he or she would
have been in a much better position.
Fortunately, Numotion, a leading provider, made a bold move
to assist Alliance consumers who were stuck, as was reported, "These clients are full time wheelchair
users and are at grave risk should their wheelchairs fail and they cannot find a provider willing and
able to offer service and repairs. Numotion has made the decision to provide access to repairs for any
client owned wheelchair to all former customers of Alliance Seating and Mobility. Paul Bergantino, Numotion
CEO, stated, 'While we recognize the payment risk we feel that the customer's wellbeing is paramount
and we will work hard to fill the void left by Alliance. Our concern is with these clients and we will
do what we can to see that they remain safe and independent.'"
Numotion did a fantastic job coming
to the rescue of Alliance consumers, and rightfully should be commended. However, it was a unique situation,
and if you need to switch providers, you need to live by documentation. Get it and save it.
is in the Paperwork
When it comes to insurance protocols in funding the purchase and service of complex
rehab technology, there are no easy or absolute answers - and protocols certainly can vary based on each
insurer and provider. However, all experts agree that simply proactively compiling copies of the documentation
as you go through the original funding process - and saving it! - will likely expedite the process of
switching to a new provider down the road if ever needed.
Published 9/2013, Copyright 2013, WheelchairJunkie.com