Magazine article The Exceptional Parent

Funding Power Wheelchairs

Magazine article The Exceptional Parent

Funding Power Wheelchairs

Article excerpt

Q I have a five-year-old son with cerebral palsy. He is not able to walk on his own, but he has the ability to get around with a children's power wheelchair.

My insurance company will only cover the costs for a manual wheelchair. Is it possible to get coverage for a power wheelchair if it is recommended by a therapist? Also, is it likely the insurance company would cover the cost of buying a used power wheelchair?

A When people purchase a health insurance policy, they often assume that the insurance company will provide reimbursement for the cost of all medical services and equipment, aside from the usual deductibles and co-payments. That's a reasonable assumption, but it's not always the way the system works.

Many insurance policies specifically exclude coverage for certain services or equipment, including power wheelchairs--sometimes listed as "durable medical equipment." The first question, then, is whether your insurance policy has such an exclusion. That information should be clearly listed in your policy manual (if it's a group policy, check the "master contract" .

If no exclusion of power wheelchairs is listed, you need only to demonstrate that the equipment is "medically necessary." That requires "documentation"--letters from your child's doctor and physical or occupational therapist describing your child's condition and explaining why he cannot use a manual wheelchair.

It is important to ask the doctor and therapists also to list any additional wheelchair-related equipment your child may need, including special seat belts, switches, remote-control devices or other items. If additional equipment is listed in the original claim, and is medically necessary, the insurance company may pay for it. But if it is not part of the original claim, many insurance companies will pay only for the wheelchair.

Some insurance companies require that power wheelchairs meet certain specifications before they will pay for them. One way to ensure that your choice meets those specifications is to file a request for the insurance company to make a "pre-determination of benefits" before you purchase the chair. (Check with your insurance company to determine the procedure and forms the company requires.) The process generally takes three to four weeks. The insurance company usually will respond with a written statement approving or rejecting the claim.

Power wheelchairs and related equipment can be expensive. …

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