Submitted by Pat from Illinois in response to “What Are Your Issues?”
I recently received a letter from my health care provider Synergy - actually “administrator”, noting that my local DME partner’s submission to them for repairs to my manual wheelchair are not covered by my policy. It’s sad that my response to receiving the letter was a resigned shrug and long sigh as I considered whether to, yet again, appeal to the powers that be to support what I felt was an exceptionally reasonable request for wheelchair repair.
I feel a personal responsibility to limit the burden that I place on our overburdened health care system, and that played into my approach to having my chair repaired vs. submitting for a new chair (my chair is 7 years old, however, the titanium frame is in fine shape).
While the repairs will not be cheap, the cost for a new, like piece of equipment would dwarf them. I felt I was doing the right thing, but as always am running into the common standard of doing business in the health coverage industry. That standard doesn’t consider long-term costs to the system, preventive care/maintenance, or even encourage responsible or engaged behavior on the part of beneficiaries. Rather, it counts on those charged with its dissemination - or many of them - to be able to read the fine print of the policy and decline, decline, decline. Clearly they know that most beneficiaries won’t have the stomach or capacity to actually appeal a denied claim, and will ultimately capitulate and either forego care or support, or pay personally and relieve the system of any responsibility.
I expect that I will, in fact, appeal this unwarranted rejection of reasonable repairs to my wheelchair, continue to pay my premiums, and accept a lower quality of life in the interim…regardless of the outcome.
I applaud your persistence and sensibility. I, too, am appalled at the overwhelming cost of buying something new when the old thing could just be repaired. I’m going through this with the legs on my wheelchair. They have needed to be replaced for about four years now but it is impossible to find anyone who has them in stock or can order them.
I live in a large town/small city in our options are limited. Up to this point I have been able to find folks who consider this kind of repair a challenge to their skills and help me out. I’ve spent a fair amount of time at the local hardware store searching for just the right size screws and bolts as well as electrical wire.
I have to say though that when the time comes, I will just cave and get a new chair. I just can’t find the energy or time to fight some of these battles. I wish I could. Be well and good luck.
I asked about repairs to my wheelchair instead of buying new. I was refused because I used foundations to pay for my chair when insurance decided I didn’t need an ultralight wheelchair and they refused to pay for it even with letters from doctors, rehab and three appeals. Again, it would be so much cheaper to repair my chair than to replace it. I’m so very sick of refusals and high costs of DME. If DME is purchased by an individual without insurance it is cheaper than to use insurance because insurance companies have conbtracts with DME companies and usually pay a higher price. I have experienced this several times. The whole system is really messed up so very severely.
I tried getting my almost new powerchair repaired in my town. The chair was still under warranty but the place that sold it to me was no longer in business. I tried a number of other companies nearby and was totally blown away. Excuses for not being able to do the warranty work ranged from “we didn’t sell you the wheelchair” to “we don’t sell that model here”. But, they did sell wheelchairs from the same manufacture! I can only assume that they did not want to fix it. Luckily my car mechanic was able to repair the wiring problem. I wish that car companies manufactured wheelchairs. Companies that manufacture products without setting up a reliable repair network should not be in business.