Hi. I'm Violet Marotta and I'm an occupational therapist at Saint Joseph – Park Physical Therapy in Lexington, Kentucky. Thank you for joining us today for Let's Break to Educate. The topic for today is wheelchairs and how to get one. We will cover:
The four main types of wheelchairs
The process for insurance coverage of the wheelchair
Where to start if you feel that you or a loved one may benefit from the use of a wheelchair
Types of Wheelchairs
There are four main categories of wheelchairs that may be covered through your insurance for use with various types of diagnoses and injuries.
The first is a power scooter, and these are the types of devices that you would commonly see maybe at the grocery store or when you go out. They're used inside as well as in the patient's home. They have three wheels and are driven using a tiller system with a steering wheel. The user must have adequate upper and lower body strength to manage the tiller system, as well as be able to safely transfer on and off the scooter in order to be covered through insurance. They can be broken down easily for travel, and a scooter is typically for a user who has trouble getting from point A to point B due to muscle weakness, pain, or shortness of air. And this patient using a scooter is typically still able to ambulate or walk some, but needs a power medical device to assist with some household distances.
The second type of wheelchair is called an ultra-lightweight manual wheelchair, and these types of wheelchairs are not actually power mobility devices, but they do require measurements to be taken by an ATP, or an assistive technology professional, from the wheelchair supply company and they come to fit the patient specifically for their specific needs with the wheelchair.
These types of chairs are self-propelled manually, with the use of the upper body and the lower body as able. They're specific to the patient in that they require body measurements to fit the patient, as well as offering specific seating needs to prevent risk of skin breakdown. They can break apart and are extremely lightweight to allow the user or the caregiver to easily break them apart to store in their car, etc. The lightweight component also allows them to easily be propelled by either the user or the user's caregiver.
The third type of chair is a power wheelchair. And this typically is what one would envision when you hear the term power wheelchair. This type of chair has a captain style seat and is driven using a joystick that is located on the armrest. They can be utilized by an array of diagnoses.
Power wheelchairs are helpful as they can be used inside and outside as needed, and this type of chair can be beneficial for someone who needs more than what a scooter would provide and is unable to self-propel an ultra lightweight manual wheelchair. The power wheelchair provides stability for the trunk with its captain style seat, and allows for easy transfer into and out of the wheelchair as well as easier access to driving through the use of the joystick on the armrest.
Complex Rehab Technology
The fourth type of chair is considered what we call, ‘complex rehab technology.’ And it may be referred to as a power wheelchair with tilt and recline. This type of power wheelchair is for our more complex patients, sometimes with neurological conditions, but not always, that may benefit from a chair with head and neck support, alternate driving abilities, specialty seating, empowered positioning. This type of power wheelchair requires an ATP assessment to measure the patient and determine additional attachments, as well or in addition to an occupational therapy or physical therapy mobility evaluation.
This type of chair allows the user to tilt back and remove pressure from their seated surface in an effort to prevent skin breakdown when they're unable to complete pressure relief independently. They also have the ability to recline flat and offer the caregiver assistance for positioning and changing the user as needed. They do not break down and can be used in and outside. This chair is typically a user's primary mobility and the patient spends a lot of time in this specific chair.
Since it doesn't break down, in order to transport this type of chair, you would need an adapted van where the wheelchair can actually drive into the adaptive van or an attachment to the back of your car where the wheelchair can be placed and tied down, or you can use public transport that supports the use of power wheelchairs.
There are more specific types of chairs that can fall into subcategories and an occupational therapist or OT, or a physical therapist, PT, as well as the ATP from the wheelchair company of your or your doctor's choosing, will help determine what best fits you or your loved one. In order to have insurance coverage for one of these chairs, you must have a face-to-face with your doctor where a mobility limitation is documented by the doctor and the need for a power wheelchair or manual wheelchair is recommended. The doctor will then refer you to a wheelchair supply company and request a mobility evaluation from either an OT or PT.
Now, it is important when choosing an OT or PT that the therapist has experience completing wheelchair evaluations and is knowledgeable of the type of documentation necessary to apply for insurance approval. And that can simply be done by just asking your doctor or asking the therapy clinic that you call if they have a therapist on site who knows how to complete these wheelchair evaluations.
Wheelchair Evaluation Criteria
The OT or PT will either see you in the clinic or they may offer telehealth as an option. Telehealth has become more popular since the pandemic and has provided an abundance of opportunity for our homebound community to get equipment that they may need.
In order for telehealth to be completed in your home, you or someone who can assist you must have access to the internet and either a smartphone or a computer with access to the specific telehealth app that is required to be downloaded. During the evaluation, the OT or PT will ask your medical history and find out how you complete your MRADLs or what we specify as mobility-related activities of daily living. And that can be anything. These include, but are not limited to, dressing, bathing, grooming, feeding, toileting, meal prep, and home management, and how much assistance you need to complete these activities during the day.
You'll then discuss with the therapist what type of chair best suits you and your needs. The OT or PT then writes up an evaluation that supports the chosen piece of equipment and then they send it to your wheelchair supply company. From there, the wheelchair representative will collect necessary documentation from your doctor and the OT or PT and submit it to insurance for approval.
The wheelchair company will contact you to tell you what type of coverage your insurance company provides and approximately how long it will take to receive your chair. They will then order the wheelchair for you and deliver it to your home.
If you think you or a loved one would benefit from a power wheelchair or an ultra lightweight manual wheelchair, the first step is to make an appointment with your primary care provider and request a face to face for a wheelchair.
The doctor will document why they support your need for a wheelchair, and then either refer you to a wheelchair company or an OT or PT with experience with wheelchair evaluations that can complete the mobility evaluation, and then possibly help navigate the process and find a wheelchair company for you. Both the doctor and therapist will decide what type of equipment will best suit you and your specific needs, and then they'll go from there.
So, thank you again for joining us today for Let's Break to Educate. If you have additional questions, please don't hesitate to call our office at 859.313.1699 or visit our website, www.CHISaintJosephHealth.org.
Thanks and have a great day.