Insurance & wheelchair/strollers

[Anonymous]

Gm! I feel like I know the answer to this- but I thought I’d ask.
Has anyone had luck success getting insurance to pay for a SN stroller/wheelchair? Like this one https://www.1800wheelchair.com/product/special-tomato-eio-special-needs-pushchair/
FWIW, DS has an autism & ataxia diagnosis. Can walk for short stints, but bc of ataxia really wears out easily.
Also, would be interested to hear if anyone has had success using a FSA to purchase similar items.

[Anonymous]

You can absolutely use your FSA. Insurance is going to be plan specific.

[Anonymous]

Do you have a prescription and letter of medical necessity? If so, absolutely.

[Anonymous]

It can be more difficult that PP is suggesting. Many (probably not all) insurers follow Medicare’s guidelines for durable medical equipment [in addition to seniors, Medicare covers patients of any age with certain disabilities, unless they are poor enough to qualify for Medicaid].

Often the person is required to demonstrate that they need a wheelchair at virtually all times, including inside their home, for it to be covered.

https://howtogeton.wordpress.com/2017/09/23/how-to-find-out-your-insurance-companys-policies-for-medical-equipment/

[Anonymous]

Anonymous wrote:Do you have a prescription and letter of medical necessity? If so, absolutely.

Ok- so that’s what we would need? We are really clueless.
Is the letter of medical necessity something the Dr generates Or a form we give to the pediatric team?

[Anonymous]

We just started talking to our insurance about this. They said we would need a letter of medical necessity and prescription from our doctor. We also needed to say that traveling from around the house or in a larger building could be difficult. That's a bit of stretch for our daughter (4 year old, genetic disorder) but is true if she is tired or if we really have to go across the house.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Do you have a prescription and letter of medical necessity? If so, absolutely.

Ok- so that’s what we would need? We are really clueless.
Is the letter of medical necessity something the Dr generates Or a form we give to the pediatric team?

That's a place to start. And yes it is something you ask your doctor for. And at the same time closely read what your insurance policy says about durable medical equipment coverage. It will vary depending on both the insurance company and the plan your employer contracted for (assuming it's a plan through your employer). Sometimes your HR department can help get an answer too.

[Anonymous]

Our ortho writes the prescription
Our PT writes the LMN

[Anonymous]

One of the things with a LMN, you’re going to ha e to have a statement as to why this one is needed. In reading the description of the chair, it’s designed for kids with special positioning needs. You didn’t mention this in your post, but it’s something to focus on.

[Anonymous]

Anonymous wrote:One of the things with a LMN, you’re going to ha e to have a statement as to why this one is needed. In reading the description of the chair, it’s designed for kids with special positioning needs. You didn’t mention this in your post, but it’s something to focus on.

Ok, thanks!
I was just using this chair as an example- but that’s a good reminder.
We want a chair so that DS can continue to take part of the kind of outside of the house things he loves, & have his gross motor needs met. Otherwise- we end up carrying him and or/just waiting for his legs to fire back up.
It might be a dead end- but it’s worth looking into.
Thanks again!!

[Anonymous]

How old is he? If he's under six you can probably find a regular stroller to fit.

[Anonymous]

NP here. My child has a physical disability uses a wheelchair and it is covered 100% by insurance. Work with a good vendor and THEY will work with your insurance company. We use Numotion and can’t say enough good things about them.

Start the process NOW. It usually takes 3-5 months from the time we start to when we actually get the chair.

[Anonymous]

Anonymous wrote:How old is he? If he's under six you can probably find a regular stroller to fit.

He is 6. Finally busting out of the stroller.

[Anonymous]

You can also try Lollipop Kids Foundation and Equipment Closet

[Anonymous]

Anonymous wrote:You can also try Lollipop Kids Foundation and Equipment Closet

Yes! http://www.lollipopkidsfoundation.org/programs/equipment-closet/

Also this organization is similar: https://www.equipforchildren.org/equipment-donation-program.html

I believe they charge just $50 for each piece of equipment, and may even waive that if you are low income.

It can be a PITA to get insurance to cover this, especially if your child can walk independently, but it each insurance company may handle it differently. You'd have to call your health insurance customer service to see what is covered, and what documentation you will need to get anything covered.