Julie:

Before I tell you my story, let me just say that my dad used one of those hover-round things when he was in Florida. Saved his life. He went everywhere, (they actually made him the mailman at the nursing home he was at). He just loved it. His was collapsible and fit in the back of a taxi when we went to take him out. So if you get one, you'll love it.

Now on to why I'm writing this post.

Years ago I tried to get a wheel chair for my hubby,Alan, (when his neuropathy was so bad he was on a fentanyl pain patch). He had just gotten disability and I felt he could use a wheel chair to get around better. He was also morbidly obese at the time.

Since I knew that the medical management department of our medicare HMO covered wheelchairs, I called them up.

This is what I was told (and probably things have changed now but I have no idea if they changed for the better or it's just harder to get an electric one).

The person told me "can your husband use his hands"? I said 'what do you mean"? He said "we only authorize the electric ones on people who absolutely cannot use a manual wheelchair".

He then said further: "If his hands can't manually wheel the chair, and we see this, only then can we authorize an electric one".

So, because Alan's hands were fine, I just dropped the whole thing.

Now, this month, he is being operated on and he NEEDS A WHEELCHAIR.

It's an 80/20 co-pay with 20% being paid by us. It's done as a rental on a month to month basis.

I called the company that contracts with our medicare HMO. They dont' do electric wheelchairs whatsoever. Only manual.

You obviously are talking about the scooter store, or the hover round or some such electric marvel, right??

And because you have been having problems with your hands hurting, well I would think you would have no problem whatsoever getting approved.

Just make sure that the company you are doing business with definitely provides electric ones.

We live in a day of insurance coverage nightmares. You are lucky that you are being evaluated. That means that you found a company that indeed offers electric ones, right?

We were not so lucky this time.

When Alan got the go-ahead for the surgery, I immediately phoned his HMO provider and got the name of the medical supply place that they contract with (for wheelchairs). I called them. They said "we don't do electric, only manual). I said: "no problem, he can use a manual, so what do we have to do"

They told me "oh it's easy, have his doctor fax us the prescription for the wheelchair, we'll get authorization from your insurance company, and we'll deliver the chair. SOUNDS GOOD SO FAR, RIGHT?

So Alan goes to his doctor yesterday (I wrote down all instructions on what the doctor had to do and where to fax the prescription). The doctor wrote the presription and sent the fax.

Alan comes home, I came back from another doctor visit, the phone rings, and it's the wheelchair company saying "we just got the faxed prescription from your husband's doctor". I said 'great, when are you delivering the chair?"

They say "I have no idea why you think you are getting a wheelchair from us, we don't contract with your insurance company and we don't contract with any HMO's."

I just looked at the phone. I said 'thank you, I'll call his insurance company."

I called my husband's insurance company, told them what I was told, she comes back with "they are wrong, they most certainly DO contract with us, you call them back and tell them to give you the chair".

So I call back the wheelchair people and tell them what the insurance company is telling me. I said "you DO contract with this insurance company". The girl says "well I checked with my supervisor and she says we do NOT contract with any HMO's." I said 'With all due respect, your supervisor is mistaken, please call up Provider Services at my insurance company and they will tell you that you contract with them".

She was very nice and said "okay, but I'm telling you, we do NOT contract with any Insurance HMO's." I said "just give it a whirl, can you please call me back?" she said 'oh, no problem".

I look at Alan and I said 'want to be $5.00 that we are going to get a phone call back and they will say "give us more information, and we'll send you the chair".

30 minutes later the phone rings and it's the girl and she's laughing and she says "give us your husband's insurance information and the number on the back of his insurance card". I had already given them the Provider Services number but they wanted the customer service number.

I said "No problem". She then said: "It seems that we DO contract with them. But we are making sure, and I'll call you on Monday and we'll probably will be deivering the wheelchair sometime next week"

Over 2 hours calling back and forth between insurance company and wheelchair company (which I had already did last week). I'm very thorough and I cross all my t's and dot my eyes), if you get my understanding.

We deal with people who are supposed to know what they are doing, tell us that they know what they are doing, but ultimately WE HAVE TO BE THE ONES WHO TELL THEM HOW TO DO THEIR JOB!!!!

So whoever you are dealing with, when the time comes, CROSS YOUR T's and DOT YOUR I's. It's an old expression. It means, make sure you have the coverage and they indeed will approve the chair.

And you will probably get the electric one because of your hands.

I think it's interesting that you posted this right after I had all this nonsense with a medical supply company.

I hope your experience is much better than mine has proven to be.

I wish you well.