My Insurance Only Covers Part of My Machine, Now What?

By Brittany Laws

You’ve went to you doctor for a mobility exam, the paper work has been sent to the supplier, and you finally receive a call that “good news, you qualify for a power wheelchair!”  As the conversation progresses and your representation is setting up a delivery plan and going over the specific power wheelchair that you will be provided, “a Jazzy chair, with standard options, no additional accessories…”

You ask, “What are standard options?”

Standard option come on all basic power wheelchair and they are included in the base price the insurance is willing a pay. Standard power wheelchair come equipped with:

  • Standard captains seat cushion with headrest
  • Standard fixed armrest with a joy stick control
  • Battery operated motor base, with a blue or red solid base cover
  • Solid tire, solid caster tires, and anti tip wheels
  • A standard foot plate.

Unfortunately, most insurance will only pay for standard options unless your doctor has medically justified any special options.

So insurance will only pay for part of your power wheelchair. Now what?

This should not be a major issue as you should not receive any features on your power wheelchair that insurance will not cover, unless you requested the item before delivery. Commonly requested items that do not come standard are:

  • Elevated leg rest
  • Seat cushions
  • Cane and oxygen holders
  • Cup holders
  • Baskets and saddle bags

However, most of these items can be covered if correctly documented in your mobility exam. Elevated leg rest, cushions and oxygen holders must be found medically necessary for insurance to cover them. (ex. If you have severe edema in your lower extremities, insurance will pay for elevated leg rest for your chair.)  Cane holders, cup holders, baskets or saddle bags are considered luxury items and are not ever considered medically necessary, so insurance will not cover these items under any circumstance.  Meaning these items will be an out of pocket expense for you. Nevertheless, they are not very expensive. Prices do vary, but most of the time suppliers can offer a flexible payment plan.

There are some features that are more advanced and will require specialty evaluations by physical therapist or occupational therapist. Example:

  • Power options, such as a tilt and recline feature

There is no need to worry about insurance paying for only part of you power wheelchair. Our specialist work with you and your doctor to ensure that all the features you need will be provided and covered by your insurance. Click on our Qualify through insurance form today to get started on obtaining your power wheelchair, or give us a call at 888-345-1780.


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