Tuesday, May 8, 2012

A New Wheelchair?

My resentment for Sadie's wheelchair has slowly been growing over the last few months.  It's now to the point that even the stupidest little things about it drive me crazy, like the noise it makes as we walk down the street, or it's color.  It's dumb, I know, but it's like a festering wound.

And while that has been happening, I've also been coveting some of my friends' wheelchairs that I've seen pictures of online.  They have pretty colors and the pommel between their child's legs and all sorts of cool stuff.  Cool stuff that wasn't even offered to us as an option.

So then my resentment has grown for the system.  Because wheelchairs that are Sadie's size cost anywhere between $2700-$3500, and when our private insurance will only pay 80%, we have to rely on our secondary insurance (which is the state provided insurance given because Sadie's disabled) to pick up that 20%.  And the only way they'll pick up that 20% is if we go through the wheelchair clinic...whose options are very limited I'm realizing.

Naturally, in these circumstances, I start wondering how we can get Sadie another wheelchair.  I want one that is more supportive, has the pommel, will tilt back if she needs to recline, has a separate base for use indoors, etc.  Will private insurance pay for another one?  Do we have to wait a certain amount of time since the last one we ordered?  (some insurances only let you order medical equipment once a year, or once every 3 years if it's big like a wheelchair)  Will we have to pay the 20%, and if so, how are we going to do that when we're saving up for a van right now?

Then I remembered how successful Sadie's ipad fundraiser was, and I got this grand idea to do another fundraiser for Sadie's wheelchair.  After talking to another mom this weekend, I got all worried that we'd have to pay full price for another wheelchair.  But I figured we could probably raise $3000 for Sadie's new wheelchair.  I told Brian about my grand idea and he wisely advised that I call insurance and see what our situation is before I start asking people for money.

This morning I called insurance, and you know what I found out?

1. We have unlimited benefits for ordered medical equipment.  I specifically asked, "so if we order a wheelchair and a walker in the same year, they'll both be covered?"  She said yes.

2. Sadie has met her deductible this year already, as well as her co-insurance payments (these are the co-payments and 20%s that we have to pay for stuff).

3. Her year goes until Sept 30, and any medical equipment we order before then will be covered 100%.  Again, I asked specifically, "so as long as we order a wheelchair before October 1, you'll pay for it 100%?!"  She said yes, as long as their in-network.  (For an out of newtwork provider, they will provide 40%)

4. The bad news is that we also have a family deductible, which also starts over October 1, and our baby is due October 11...which means we will get to pay all the deductibles/copays to the hospital when we have our birth!!  That's unfortunate timing.

So, I started shopping!!

Then I learned more.  I can't just order a wheelchair.  I learned this when I called my first company.  The guy was really patient with me.  He told me I basically have to go through a middle man.  I'm sure I sounded clueless, so he goes, "I'll just name some and you tell me if any of them ring a bell."  One that he mentioned was United Seating and Mobility (USM).  I told him that's who we went through for her other wheelchair through CRS so that's probably fine.  But when I hung up, I was probably more confused than when I started.

What is a girl to do for answers in this situation?  Who can she call to ask silly questions that she can trust not to make fun of her or get frustrated?  Tami.

I had to call Tami for something else anyway, so I was like, "since I have you on the phone..."  Tami told me to call a guy at USM and tell him which wheelchairs I wanted to see.  Then he'd call those companies and set up times for a rep to come out and bring the equipment and show us their stuff.  We don't go through the wheelchair clinic, we go strictly through USM, who then orders and bills etc.

And USM is an in-network provider.

I called and left the guy a message since he wasn't available.  I've picked out 4 chairs that I want to see. All of them recline.  All of them have a separate stroller base and inside/activity seat base.  All of them turn around in the stroller base so she can either face me or face out (which I think is awesome for those intense sensory experiences like Costco).  Hopefully this USM guy is able to reach these companies' reps and get us in to try this stuff out.

So stay tuned.  Hopefully we will have more wheelchair news soon...and hopefully it'll be good news.


  1. What wonderful news!!! I am so excited for you...my aunt's insurance (Medicaid) will only pay for equipment every 5 years. Or we private pay. I can't wait to see Sadie's new wheels!!!

  2. So what happens to the old wheelchair that is what, month's old? Would the company or organization you worked with to order the first chair do a trade out, or perhaps a credit towards the type of chair you want because this one does not adequately meet Sadie's needs?

    One thing I would clarify with the insurance company. With my policy goods or medical services must not only be ordered but received, signed off by me within the coverage period. If the chair was ordered on September 1 but not delivered until October 15, outside of the coverage period, you would pay the new deductibles. Policies vary but it is something to check.

    1. That's a good question!! We are keeping the old wheelchair. It's more of just a giant stroller, and it's got its purposes. It folds up really well and is really portable, and it's a good just go out and run errands wheelchair/stroller. But it's also too big for her, so as she grows it'll become more and more useful because we'll be able to use straps and foot things and stuff.

      We'll hopefully be ordering her chair LOOOOONNG before September 1!! But thanks for the heads up!