|Permobil’s C500 Stander combines the critical benefits of standing with the convenience of driving the wheelchair while standing.|
There are many benefits to standing with a standing frame or wheelchair, says Teresa Tisdell, an occupational therapist (OT) at Integris Southwest Medical Center’s MDA clinic in Oklahoma City. Some medical benefits for people who are sedentary because of neuromuscular disease include improved blood circulation, increased range of motion, stretching of tight muscles and tendons, and relieving pressure on internal organs.
Standing wheelchairs offer a new level of independence and allow you to change your position throughout the day. For more information on the benefits of standing, see “Why Standing Is Worth the Weight” (January-February 2004).
To help you through the process of funding your standing device, Tisdell recommends working with your MDA clinic team, which comprises your OT or physical therapist (PT) and a rehab technology supplier (RTS) or assistive technology supplier (ATS).
“What you have to do is determine if there’s a medical justification for standing,” says Tisdell, who’s been an OT for 11 years. “Basically, you look at issues like circulation, bone density, contractures, edema, digestion and tone, and how the standing feature will improve management of these problems.”
Each case presents its own funding challenges, whether you’re insured by Medicaid, Medicare or private insurance. The outcome depends in part on your medical needs and the creativity of your MDA clinic team.
It helps to have several professionals expressing your need for a standing chair, Tisdell says. Don’t give up, be persistent and try to figure out a way to make it work.
Quest readers who rely on public insurance for their health needs will find that, in many states, Medicaid has covered some types of standing frames and standing wheelchairs. But the pathway to getting the coverage you want can be long and twisted.
Michael Overall's story
|Michael Overall, who has nemaline myopathy, still has a ways to go before he can enjoy the benefits of owning a LifeStand.|
Michael Overall, who has nemaline myopathy, desperately needs a new power wheelchair (his is falling apart). After Overall, 28, met with his Oklahoma City MDA clinic team — Tisdell and Randy White, a certified RTS with CV Medical Solutions — they determined that a standing wheelchair would best meet his needs, both medically and functionally.
Being able to stand will expand Overall’s employment possibilities. It would also reduce his need for caregivers to assist with many activities of daily living, and, as Overall has discovered, open up his opportunities for social interaction.
“People respond to me differently when I’m standing,” Overall says. “I feel like I command more respect.”
Power standing wheelchairs are expensive — ranging from $18,000 to $30,000. To Tisdell’s knowledge, Medicaid in Oklahoma hasn’t ever covered a standing wheelchair, but that doesn’t mean it’ll never happen. Overall’s MDA clinic team is devoted to his case and has vowed to do everything possible to get him the standing chair.
“There’s a lot of equipment out there that can help people have a better quality of life, but it’s very difficult to get it funded,” Tisdell says. “So that’s when you have to work together with your clinic team, looking at your resources, determining what is medically necessary, getting creative with what is available and figuring out a way to get what you need funded.”
|The Magician Comfy Seat sit-to-stand stander from Altimate Medical is adjustable to grow with your child for many years and can accommodate children with different levels of ability. Altimate Medical has published a guide to help you obtain funding for standing frames. Visit easystand.com to download the guide.|
|The Redman Chief compensates mechanically for body position, so armrests and positioning devices stay with you as you move to a standing position.|
First, the MDA clinic team discussed Overall’s situation with his Medicaid case manager, explaining the urgent need for a power chair and the importance of a standing wheelchair for both medical and functional reasons.
The next step was to speak with the durable medical equipment (DME) dealer. The company, CV Medical Solutions, agreed to help Overall get his chair, even if it wouldn’t make a profit.
After it had been determined which brand of standing wheelchair would work best for their client’s needs, the MDA clinic team asked the product’s manufacturer, Frank Mobility Systems, if Overall could purchase a demo wheelchair at a reduced price.
The list price of the LifeStand was originally $26,829. Between the LifeStand demo and the DME dealer discounts, the price was reduced to $12,673.
“I called CV Medical Solutions, and I said, ‘Can we divide out all of the parts that are standing components on that wheelchair and all of the parts that are regular wheelchair parts that would go on any power wheelchair (wheels, batteries, etc.), and submit to Medicaid only for the parts that you’d pay for no matter what wheelchair the person got?’” Tisdell says.
Finally, after a year-long process, involving three letters of medical necessity and denial appeals, Medicaid approved payment for a standard power wheelchair base ($5,025).
The price to upgrade to a standing chair would be $7,648. That’s when MDA would come in with its $2,000 toward the purchase of a wheelchair or leg braces. (MDA allows this amount every five years for an adult or every three years for a child 18 or under.)
As of the end of March, Overall still needed to find $5,648 in order to get the wheelchair he needs. Medicaid’s eligibility rules don’t permit him to pay out of pocket, because if he had $5,648 to spend on the chair’s upgrade, he wouldn’t be eligible for Medicaid in the first place.
“I understand that these things take time,” Overall says about his funding struggle. “I try not to get frustrated because everyone is doing everything they can to help me. Keep trying — in the end it’ll work out.”
CV Medical Solutions is holding a chair for Overall while he looks for funding. Overall and his MDA clinic team are checking out additional resources to fund the $5,648 upgrade.
Nontraditional funding options they’re pursuing include: