Ready to scream!
By Thoroughrob
@Thoroughrob (11742)
United States
April 16, 2012 9:58pm CST
For almost a year we have been trying to get my son's wheelchair fixed. He has grown and it doesn't fit him right. Also the headrest broke off, and took a big chunk out of the back of the chair. It was done on the bus, not sure what happened, just guessing he pushed his head back against it. The chair is 2 1/2 years old. It cost over 20,000.
My insurance, has approved the repairs. My son also has medicaid because of his disability. The wheelchair company will not repair it because the amount they are going to get from the insurance, will not cover the chair. Medicaid will not pick up any more than the insurance is paying because the insurance says they are paying 100 % of the allowed amount. They are not allowed to accept payment from us, because it says that we are not responsible. I am at my wits end. He was also supposed to get batteries and wheels with the repairs.
Two weeks ago, his batteries started acting up. They stay charged during school, but by the time he gets home, is about dead. I contacted the company. The only way they will help is if we pay $600 for the batteries, and they will submit it to insurance, whatever the insurance pays, they will send us back. Like I just have $600 laying around.
I have looked online, and the I did find one place I could order them, but they won't take insurance is $495 for the pair. I don't know what we are going to do. My husband is just about ready to go through the roof. If anyone has any ideas, please let me know! Have you ever had to deal with insurance like that?
Thanks for listening to me vent!!
4 people like this
10 responses
@SomeCowgirl (32191)
• United States
17 Apr 12
This is just a headache for you and a unnecessary one at that. The only thing that popped into my mind is possible looking around to see if any medical accessory store has a part or parts for you that you can get at a better price. Also maybe trying church organizations that have the same thing.
When my mother passed away my aunt donated some of her medical needs to a medical store of some sort, I am not sure how she knew of it etc, but I do know they exist.
I am hoping you can find something or someway to get this chair fixed, it should not be this difficult on you and your family. Insurance and Medicaid laws and regulations are ridiculous!2 people like this
@Thoroughrob (11742)
• United States
17 Apr 12
I spend so much time getting the run around, it is not funny. I think they should have to pay the people for all the agony they put them through. It seems no one has any answers anywhere.
2 people like this
@Thoroughrob (11742)
• United States
17 Apr 12
I have case management, but they act like they have never heard of such a thing. He has Cerebral Palsy. I wish I could find someone with some knowledge instead of a blank face. We have our department of MRDD and that is where our case management comes from. I even contacted the state medicaid office. I wish there was someone you could just go to and tell them to figure it out, but by the time they were done, I would owe them more than the chair repair lol.
@GardenGerty (160996)
• United States
17 Apr 12
I do not want to sound blunt, but what disease or disorder does your son suffer from? I think you could approach any organization that has that same name to advocate for you or to help you find what you need. For instance, if he has MS, approach the MS Foundation. You and he need a family advocate or state ombudsman. Is there a state organization for the developmentally delayed? Is there a local place that can take over case management for you, which is what usually is done around here. We have four agencies in town that work with the physically and mentally handicapped in providing services and until they are eighteen those services are just things like case management. A good case manager will know how to fight those paperwork demons.
1 person likes this
@KrauseHome (36447)
• United States
17 Apr 12
Wow!! That is unreal. Goes to show how poorly the Insurance system with Medicaid is being ran. You would think they would want to try and help someone instead of making their life difficult and wait. Personally the way the Health Care system is going it is getting scary, and people that are healthy are the only ones with hope.
@Thoroughrob (11742)
• United States
18 Apr 12
It looks like it but it is just so crazy. I just cannot believe that the company is not allowed to accept payment from us, it has to come from someone else.
1 person likes this
@Thoroughrob (11742)
• United States
19 Apr 12
I really don't want to pay out of pocket, but would if they would let me. Because insurance is paying the contracted allowed amount, medicaid won't pay any, and they are not allowed by law to take money from us, so the wheelchair just will sit without being fixed.
@AmbiePam (94045)
• United States
8 May 12
This was posted three weeks ago so I'm hoping something has happened to help. I'm so behind in my e-mails. Are their charitable foundations that could help you out? Any websites like wishuponahero.com? I wish it was more straightforward with getting help whether it be a charity or insurance.
@Thoroughrob (11742)
• United States
8 May 12
Nothing new, still looking, but getting the run around. Because he has insurance, and medicaid, agencies do not want to help, as it should be covered in their eyes. Because the insurance says they will pay the allowed amount, medicaid will only pay 20% of the allowed amount that the insurance says should be left over. They cannot bill me because we should not owe it, but the company will not fix it because they will not even get enough money to pay for the parts. We are still trying to talk to the insurance and medicaid, but that is like a big waiting game.
We have dug his old wheelchair out and started fixing it up, to a runnable condition, just in case. We don't know what else to do.
@macdingolinger (10386)
• United States
17 Apr 12
Wow! I thought I had seen and heard of about everything! lol Obviously there are more ludicrist people out there than the ones I have run up against with my son. I have a lift that medicaid paid for that sits in the closet because i do not need it - I haven't used in in two years.. but no one (I don't have insurance) will buy the sit-to-stand that I need! ... the system is crazy and fighting it can make us crazy if we let it! I have never heard of a company who will not take money for services.. you cannot get much dumber than that!!! I wish I knew where to send you for help but I am afraid that all I have to offer are the same types of stories to share!
@Thoroughrob (11742)
• United States
18 Apr 12
That is so strange. I am getting a sit to stand lift. Insurance and medicaid will not buy that either. The only kind they will pay for is a hoyer. I was lucky and the county board sent a lady to me that was Family First. Because it is not tied up in insurance, and medicaid they will help, but not the wheelchair because it should be covered by the insurance and medicaid. The big thing is that I cannot pay for the difference in what the insurance will pay because of Medicaid and the contract they hold with insurance, so unless someone else pays the difference, they will not even fix it. I was watching craigslist for a sit to stand lift. I found many that were electric, but really only wanted and needed a manual one. Do you have a social service person at the hospital you use? The one that we used to go to had a group that was anonymous. that would help with things that insurance and medicaid would not.
1 person likes this
@macdingolinger (10386)
• United States
18 Apr 12
I do not have a hospital but we have home health. I have a real good nurse/worker who is pretty good with stuff and at least tries. But since I have the hoyer they will not get the sit to stand. I did price a standing frame last night that I want there's no way that they will buy it for Chris although that's what he needs. My hoyer has been in the closet underneath a huge pile of junk for more than a year now. I simply do not use it. I thought about selling it and putting the money toward a sit to stand. The regs seem so blanket and "standard" that there's no reasoning allowed.. I have tons of horror stories already! lol
@GardenGerty (160996)
• United States
17 Apr 12
I know that the Shriners do a lot for crippled children, and also there is a hospital in Saint Louis that does a lot, but I do not know if they would have any resources to help you with the chair. Those chairs are expensive, partly because there is a monopoly on making and servicing them. Is there a local health equipment company that will advise you?
@Thoroughrob (11742)
• United States
17 Apr 12
I have been to shriners, and they do a lot but if you have insurance they use it. I will give them a call. We quit going to them just because of the distance. I had not thought about them, thanks. I am going to call the local DME companies around here tomorrow and see if someone will help us with the batteries at least. Someone should be able to order them for us as the insurance has already said they would pay their part. I did think about leaving out the medicaid part and see if they could just find out what we would owe.
1 person likes this
@Hatley (163776)
• Garden Grove, California
17 Apr 12
hi thoroughrob this is where sometimes ones local congresswoman or man can be contacted and most often they will help in cases like this where you run into big obstacles. good lord they get paid big b ucks to represent your state and your area so do find out who they'are and present your case.you should be able tol get some helpfrom them as they have far more clout than we individual
citizens have. contact your local congress person and get him or her working on your case. let us know how things turn out . good luck and God bless. from hatley.
from hatley.
@bunnybon7 (50973)
• Holiday, Florida
17 Apr 12
i hope you get it right soon. i read the other responses and they had about all the things to be said already mentioned. things like this makes me wonder what good is Obamas health plan doing 
@dorannmwin (36392)
• United States
20 Apr 12
As far as what to do about getting your son's wheelchair fixed, I am afraid that I do not have any suggestions to offer to you.
Now as far as being frustrated with insurance, that is something that I feel like I am constantly dealing with. Since Tom got the cancer diagnosis last year, he has had over $100,000 of medical procedures done. Now, for the first several months, our copays were very reasonable, being fifty dollars per treatment. However, somewhere in the middle of the treatments, the copay increased to 20% of the allowed amount. This means that we have been billed over $3000 for each of his radiation treatments and there were 16 of them. Just like you, I don't have $600 laying around, let alone $48,000.
