Quantum Rehab® does not sell direct to consumers. We do not establish the price at which the chair or safe seat elevation is sold to the end user or a third-party payor, and as such we also do not bill Medicare or other third-party payors. We only establish the manufacturer’s suggested retail price (MSRP). Instead, we work with a network of rehab equipment providers that can work directly with you and your third-party payor to help you get the chair and any options (including safe seat elevation), accessories, seating and positioning components you need.
Most payors deem the reasonable and useful lifetime of a wheelchair to be five years. Please note that many third-party payors will not cover the purchase of a new power wheelchair until the old chair has reached a five-year reasonable useful life threshold. However, if there has been a change in your medical condition such that the current chair CANNOT be made to meet the new medical need, then a new power wheelchair may be authorized.
All third-party payors (except traditional Medicare) will consider the request for a complex (customized) rehab power wheelchair with a power adjustable seat height system on a case by case basis.
There is no list of diagnoses, conditions or level of disability that will automatically deem safe seat elevation as medically necessary. Many commercial insurance companies will give individual consideration for the funding of power adjustable seat height when they understand your identified needs and the impact seat elevation will have on your capabilities, especially if you live alone, spend a portion of your day alone or require less personal care assistance to perform/participate in your activities of daily living. When submitting a request for prior approval to your third-party payor make sure information with regard to what you CAN do with the seat elevated (and at what height) vs. what you CANNOT do, require assistance to do or are unsafe in doing with a low, static seat is presented so that they understand why it is a reasonable and necessary feature. As a reminder, if it is not submitted for prior approval you have no opportunity for the insurance company to review and consider the request.
If the third-party payor denies your request for powered mobility (or a power wheelchair with safe seat elevation) make certain they explain WHY they denied the request as you have appeal rights. It is possible they did not receive sufficient detailed information as to WHY you need to use this feature, exactly HOW it benefits you and WHEN you will use it throughout the day.
It will be important to show what you are NOT able to do, or need help doing at a low, static seat height and then also document what you ARE able to do with the seat elevated, and at what height. This may include transferring to/from the chair, reaching items that are overhead, being able to make your needs known without causing pain in your neck as you look up to try and communicate with others, etc.
The VA sees power adjustable seat height as a significant benefit for veterans for a multitude of reasons. They will consider funding it for all veterans who can safely operate a power wheelchair and who would benefit socially, emotionally and/or physically from using safe seat elevation.
If the primary place you need to use a power wheelchair with safe seat elevation is at work, we recommend speaking with your employer about the possibility of them covering the cost of power adjustable seat height so you can safely, timely and efficiently perform your job tasks. We also recommend you contact the Department of Vocational Rehab Services in your state as they may consider power adjustable seat height as part of your Individualized Employment Plan.
If the primary place you will use a power wheelchair with safe seat elevation is at school or college, we recommend you contact the Department of Vocational Rehab Services in your state as they may consider power adjustable seat height on a case-by-case basis if your primary (and any secondary) third-party payor denies it as “not reasonable and necessary.”