Navigating the insurance process for obtaining a power wheelchair or complex rehab technology (CRT) can be daunting. However, understanding the basics of Medicare and Medicaid requirements can make the journey smoother. This guide aims to demystify the process and help you secure the mobility equipment you need.

Private Insurance Plan Coverage for Power Wheelchairs and CRT

Private insurance plans can vary widely in their coverage for power wheelchairs and complex rehab technology (CRT). While most private insurances will pay for a portion of the cost of durable medical equipment (DME) such as power wheelchairs, it’s best to give them a call and find out exactly what you can expect.

Medicare Coverage for Power Wheelchairs and CRT

Medicare Part B covers power wheelchairs and CRT if they are deemed medically necessary. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount.

Here’s a step-by-step guide to help you through the process:

  1. Medical Evaluation: Your doctor must conduct a face-to-face examination and provide a written order stating that the equipment is medically necessary.
  2. Documentation: Ensure all necessary documentation, including your medical records and the doctor’s order, is submitted to Medicare.
  3. Supplier Selection: Choose a Medicare-approved supplier. George’s Pharmacy & Medical Equipment is a trusted provider that can assist you with this process.
  4. Prior Authorization: For certain types of power wheelchairs, Medicare requires prior authorization. Your supplier will help you submit the necessary paperwork.
  5. Approval and Delivery: Once approved, your supplier will deliver the equipment and provide training on its use.

Medicaid Coverage for Power Wheelchairs and CRT

Medicaid coverage varies by state, but generally follows a similar process to Medicare. Here are the key steps:

  1. Eligibility Check: Confirm your eligibility for Medicaid benefits in your state.
  2. Medical Necessity: Obtain a prescription and medical necessity documentation from your healthcare provider.
  3. State-Specific Requirements: Each state has its own set of requirements and forms. Work with your healthcare provider and supplier to ensure all paperwork is correctly completed.
  4. Approval Process: Submit the documentation to your state’s Medicaid office for approval.
  5. Equipment Delivery: Once approved, your supplier will deliver and set up the equipment.

Tips for a Smooth Process

  • Stay Organized: Keep all your medical records, prescriptions, and correspondence in one place.
  • Communicate: Regularly check in with your healthcare provider and supplier to ensure all paperwork is submitted on time.
  • Ask Questions: Don’t hesitate to ask your supplier or healthcare provider for clarification on any part of the process.

George’s Pharmacy & Medical Equipment: Your Partner in Mobility

At George’s Pharmacy & Medical Equipment, we understand the complexities of obtaining power wheelchairs and CRT. Our team is dedicated to helping you navigate the insurance process and ensuring you receive the equipment you need. We offer a wide range of complex rehab technology products and services to meet your unique needs. Visit our Complex Rehab Technology page to learn more about how we can assist you.