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Obtaining coverage for power mobility equipment has become increasingly difficult, as fraud has become more frequent, resulting in many insurance companies changing rules with regards to power mobilities devices. Along with this, there still exists a disconnect between suppliers and beneficiaries. We are here to help you learn more about power mobility devices, and give you guidance on who qualifies for coverage.
Who Qualifies for Power Mobility Devices
Most insurance companies have an assessment tool in place to determine who needs a power mobility device. Before the assessment begins, the beneficiary of the device must be willing to use it, and not be in the situation where a family member, nurse or friend is forcing them to use it. The beneficiary will then be assessed to see if a power mobility device will improve the health and life quality of the beneficiary by allowing them to continue with their daily routine on their own. There are then nine questions that the beneficiary, their caretaker and a clinician must answer together in person. These questions are (as per Center for Medicare Advocacy):
- Does the beneficiary have a mobility limitation that significantly impairs his/her ability to participate in one or more of the MRADLs (mobility related activities of daily living) in the home?
- Are there other conditions that limit the beneficiary’s ability to participate in MRADLs at home?
- If these limitations exist, can they be ameliorated or compensated sufficiently such that the additional provision of MAE will be reasonably expected to significantly improve the beneficiary’s ability to perform or obtain assistance to participate in MRADLs in the home?
- Does the Beneficiary or caregiver demonstrate the capability and the willingness to consistently operate the MAE safely?
- Can the functional mobility deficit be sufficiently resolved by the prescription of a cane or walker?
- Does the beneficiary’s typical environment support the use of wheelchairs including scooters/Power-Operated Vehicles (POVs)?
- Does the beneficiary have sufficient upper extremity function to propel a manual wheelchair in the home to participate in MRADLs during a typical day?
- Does the beneficiary have sufficient strength and postural stability to operate a POV/scooter?
- Are the additional features provided by a power wheelchair needed to allow the beneficiary to participate in one or more MRADLs?
Where ever possible, insurance companies will request that supporting documents accompany each answer. Some companies also require that a #1 authorized practitioner, such as a physical therapist, conduct an exam with the beneficiary in person. The practitioner will then be required to forward a script and all supporting documents to a supplier, stating that the beneficiary’s life quality will improve with the use of power mobility device.
Limitations Surrounding Power Mobility Devices
Power mobility devices that are supplied through insurance must be used inside the beneficiary’s home, which can be any building or facility the beneficiary considers to be their home. This rule has one caveat as hospitals and facilities with skilled nursing staff are not considered to be a home. Mobility scooters and wheelchairs are not restricted to remaining on one premises. The beneficiary is allowed to take their scooter to public areas, as well as on vacations, as long as the device is being used to improve the quality of life of the beneficiary by enabling them to move freely and on their own. When going through an approved supplier, beneficiaries will then be responsible to pay a 20% co-payment on the device. In some cases, the beneficiary will also be required to pay the difference between the predetermined reasonable price calculation and the cost of the device through the supplier. Purchasing a device could result in the insurance company paying no more than 80% of the allowed purchase price. If the beneficiary decides to rent their device instead of purchase, the title of the device remains with the supplier, and they cannot claim rental fees after 15 months.
Affordable Medical Supply is an approved #2 supplier to many insurances for power mobility and offers a wide range of power devices. Our friendly staff will be more than happy to answer all your questions, and offer any advice you may need when it comes to power mobility devices. For all your home medical equipment, look no further than Affordable Medical Supply.