Is There Any Hope for Seat Elevation Funding?

In our July issue, we discussed funding strategies for different types of rehab technology.

For that issue, Invacare Corp.’s Jim Stephenson gave advice on ultralightweight K0005 manual chairs…but we also asked him for an update on funding for seat elevation. Here are his comments on what may be the ultimate funding challenge in rehab.

Does Anyone Reimburse for Seat Elevation?
There are a few funding sources that do actually cover elevation — some of the Medicaid programs and so forth.

But Medicare never, ever covers it; it doesn’t matter what you say or do. It’s statutorily not covered. Medicare doesn’t deem it a medical necessity. They view it as a convenience item or a luxury item or something along that line.

(Medicare’s) view is that beneficiaries just don’t need it. They don’t need it for pressure relief, they don’t need it for catheter insertion and things of that nature. So realistically, “all” it’s doing is making their lives easier. I guess they’d rather see somebody remodel their whole house and bring things down to wheelchair level than give them 5" of elevation.

There has been a little bit of noise around the industry. I’ve heard from time to time where people are trying to fight for the cause, as far as trying to justify why elevation is valuable, that sort of thing. But with everything else that’s going on with Medicare, this is just a fly on the wall. They don’t even notice it.

So Is There Any Good News?
There is a RESNA position paper on seat-elevating devices for wheelchair users (download from the University of Pittsburgh’s Web site: position_on_seat%20elevation.pdf).

It’s got all kinds of references, several case studies, and clinical considerations people should think about — for instance, psychological considerations, like eye-to-eye conversations, which are more socially appropriate for people. Communication on a level height improves people’s self-confidence. Being at a normal level allows society to accept wheelchair users, more so than if people in chairs are “talked down to” because of the difference in height. If they can raise up and be face to face with somebody, that changes the whole perception of how people view them.

When wheelchair users are able to be at eye level with people, it keeps them from having to tilt their heads back, which can cause unnatural curvatures in their cervical spines. All that’s in the position paper.

Elevation doesn’t treat a medical situation, necessarily, but from a patient’s psychological and social status, it goes a long way.

Encourage Your Client to Act as an Advocate
There’s no magic pill; there’s no key phrase. If there was, I’d be preaching it all over the country, because I’m an advocate for seat elevation myself. I definitely see the value in it, and I think it’s a great feature and definitely has some positive impact on folks.

If you’re dealing with an insurance company, and it’s kind of a battle, there’s nothing wrong with getting the patient involved in that particular situation, and having them write, “The seat elevator would help me do this and that.” With private insurance, the patient can go to their company’s HR department and ask them to talk to the insurance benefits people to get a seat elevation funding exception made.

The social and psychological impacts of seat elevation are huge. There are a lot of folks out there with disabilities who just crawl into a shell; they just feel so outcast. Everything and anything that can help them to feel more independent is beneficial to them.

This article originally appeared in the August 2008 issue of Mobility Management.

About the Author

Jim Stephenson is Reimbursement & Coding Manager for the Rehab Department of Invacare Corp.

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