Not everyone has the luxury of having a funding source that pays for a power standing feature on a power wheelchair. If you are fortunate enough to have a funding source that covers standing, you are in the vast minority but good for you! Most payors follow Medicare’s guidelines to some extent which generally means they consider standing to be statutorily non-covered. This doesn’t mean you can’t get a standing system, but it does mean you will have to work a little harder to get it covered. Some insurance companies will make exceptions when the clinical documentation for standing is compelling enough. However, more times than not, you will need to explore alternative funding methods to get your stander.
Alternative funding simply means the money is coming from somewhere other than your typical insurance coverage. There is always the option to pay cash out of your pocket for your standing system but for many this expense is out of their financial reach. The easiest option is to approach the typical funding source (insurance coverage) with the Group 3 power wheelchair (Permobil F3). Then proceed with the Permobil upgrade program using alternative funding. Essentially get the insurance to pay for the most expensive part and cover the jump to Group 4 (Permobil F5 VS).
Some ways people find the funding include: GoFundMe, fundraisers (spaghetti dinners, raffles, etc), church, family members and some national organizations have a charitable arm that may be willing to help. For an extensive list of these organizations you can search the especialneeds.com/funding website for their contact information. Once these options have been exhausted you can request assistance from the Permobil Foundation as well.
If you feel a standing system will be beneficial to you or your client there are ways to secure funding, but you have to be willing to fight for it. Permobil’s clinical and funding team is well versed on what it takes to get a standing system covered and we are always willing to help someone in need. We can be reached by email at US_Funding@permobil.com. Happy Standing! For more information on Standing Wheelchairs, check out Landon's Journey to Standing.
Reimbursement and Coding Manager
Jim Stephenson is the Reimbursement and Coding Manager at Permobil. Over the past 25 years, he has worked on all sides of the healthcare reimbursement spectrum, the last 15 years in the CRT/DME industry. His broad background has provided him with vast experience and a unique perspective in working with funding sources, providers, physicians/clinicians and consumers. He is currently a member of the DME MAC Advisory Councils, the Complex Rehab and Mobility Council (CRMC) and the Regulatory Council for the American Association for Homecare. At Permobil, he works closely with the product development, government affairs, clinical education, sales and marketing teams. His responsibilities include: assisting providers with their coding and billing inquiries, providing support to the sales and customer service staffs and staying abreast of the ever-changing complex rehab industry.