If you are deciding on purchasing a power wheelchair to assist with your mobility needs, you may wonder if your doctor needs to get involved. If you want insurance to pay for your equipment then the short answer is yes. Other insurance providers follow Medicare guidelines for payment of durable medical equipment (DME). Chances are, if you want any insurance to pay, there will be stipulations in order to make this happen such as needing a prescription from your doctor for a power wheelchair.
Most insurance require that your physician and provider evaluate your needs and expected use of the mobility product you will qualify for. The type equipment needed will be determined by asking the following questions:
- Will a cane or crutches allow you to perform these activities in the home?
- If not, will a walker allow you to accomplish these activities in the home?
- If not, is there any type of manual wheelchair that will allow you to accomplish these activities in the home?
- If not, will a scooter allow you to accomplish these activities in the home?
- If not, will a power wheelchair allow you to accomplish these activities in the home?
- A face-to-face examination with your physician is required prior to the initial setup of a power wheelchair.
- Your home must be evaluated to ensure it will accommodate the use of the power wheelchair.
Insurance will help pay in the following instances:
- Individual mobility is grossly impaired and affects ability to participate in one of more of the MRADLs (mobility related activities of daily living).
- The limits of mobility do not improve even while using a cane or walker.
- A manual wheelchair will not provide individual medical improvement due to weakness in a patient’s arms, pain or additional handicaps/dysfunctions.
- Patient can safely transfer on and off the power wheelchair; maintain posture, stability and position.
- The equipment is intended for in-home use.
- The home has adequate space to support use of the power wheelchair.
- Patient is mentally capable of operating the equipment.
- Patient is physically capable of operating the equipment.
You will need a prescription from your doctor for a power wheelchair. In order to obtain a prescription for a power wheelchair your doctor must support these claims with physical documentation provided in the form of F2F (face-to-face) notes. If additional information is needed (usually by the insurance), you may be required to see a physical therapist or occupational therapist in addition to your primary care physician. For more information, feel free to contact us today at 1-888-345-1780 or fill out the Qualification Through Insurance form and get started regaining your independence today!