Tuesday, December 16, 2008

"Go Away! You've Already Had Your One Wheelchair!"


I hereby write what is entailed (couldn't resist) in buying a wheelchair. Take note, ye who may evolve from biped locomotion and become rolling examples of change.

Little Red, the wheelchair that stars in the concluding episodes of Seven Wheelchairs, is 12 years old. I love her. She has been rebuilt twice. I would rebuild her again and continue our journey together, but the company no longer makes parts for her.

And so, amidst worrisome noise, worn tires, and creaking mechanics, I set out to secure a new wheelchair, happily noting that the new wheelchair will be covered first by the insurance at my wife's workplace and by Medicare.

Until I learn that the private insurance allows a person only "one wheelchair to be covered." Actually, it would cover only a portion of the cost.

That means only "one wheelchair in a lifetime."

You'll remember my present wheelchair has lasted a dozen years, during which it has had three sets of motors and gears. Now, now following the oxymoronic ideal of my wife's insurance company, a person receives his One Wheelchair, and then he is required to heal or to die, ideally before the wheelchair company quits making parts for the chair.

There seems to be no provision for permanent disability.

Perhaps such a state does not exist in the alternate universe occupied by the health insurance.

No matter, I think. I bought trusty and reliable Little Red before I was accepted under my wife's insurance "open enrollment plan."

Not quite. The One Wheelchair provision applies to any wheelchair. Since I already owned a wheelchair before I was covered as a co-insured by my wife's plan (for which she pays a princely sum biweekly), I have already been allotted my One Wheelchair.

Even though that company had nothing to do with buying it.

Ah, but I turned 66 years of age this year, and so I receive Medicare.

Medicare is more generous.

No, in honor of FDR (Social Security) and LBJ (Medicare), I will happily say our floundering government insurance agency is "Optimistic."

Medicare will pay for a wheelchair every ten years.

Thus, having ordered a new wheelchair before I learned of the One Wheelchair mindset, I am not left to labor out from under the multi-thousand dollar cost alone.

We will have some coverage -- or, to put it in the simplest terms, Medicare care will look at the five-figure cost, decide how much is the allotted amount for a wheelchair, and then pay 80% of that figure.

Which means I will owe 20%.

I think.

Because even though the wheelchair lists at $10,000, the bill (see the reference below about the MD, PT, and fitting expert) is $20,000.

Alas, the plot yet grows slightly more complicated.

Wheelchairs use a solid metal plate for a seat. A "seat pan." People who use wheelchairs use foam or gel cushions upon which to sit.

Or, as we refer to my very comfortable Jay cushion -- artificial butt fat.

As Little Red wheezes about desiring repair, my Jay cushion sags. The Jay has had its gel packs replaced once or twice, and there are signs that I may soon be confronted with another leak. My current cushion is on its last legs, so to speak.

But Medicare does not consider a gel cushion a covered item.

Or to state it another way: Medicare iss happy to authorize a wheelchair for me -- after I met with a MD, a PT, and a "fitting expert" to fit the wheelchair to my frame so that I will not get the pressure sores that I am certain to get if I cannot afford a wheelchair cushion.

The wheelchair cushion costs another $900.

I bought it.

This procedure began in July. The wheelchair was delivered yesterday.
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