It goes without saying that hygiene is an extremely important part of living with a disability, but Medicare and most private insurance companies consider bathing and showering to be a convenience and not medically necessary. However, even though some insurance companies may not be willing to cover anything beyond the bathroom door, that shouldn’t stop you from getting the bath bench, tub slider or shower chair you need. You may need to get creative, but many avenues of funding exist for all types of bathroom equipment.
Durable medical equipment is defined as any specialized piece of medical equipment that your physician prescribes for you to use at home. DME also must be able to be used on a long-term basis, be medically necessary and not be useful to someone who isn’t sick or injured.
The largest barrier to insurance reimbursement is defining what equipment is truly “medically necessary” and what just makes life easier. According to the insurance giant Cigna, something is medically necessary when it is used in accordance with generally accepted standards of medical practice, is clinically appropriate for the patient’s illness, injury or disease and is not primarily for the convenience of the patient or physician.
Navigating the dizzying maze of rules and regulations might be overwhelming, but if you find that coverage isn’t possible, there are grants and equipment loans to help you get the right bathroom equipment.
Funding May Be Available
Medicare covers many types of DME, but they most likely won’t cover bathroom equipment. While Medicare is not a funding source, Rick Goldstein, CEO of Go! Mobility Solutions, recommends to his clients that they submit a claim to Medicare anyway. “Go ahead and provide a prescription and a letter of medical necessity, which would make it medically necessary and therefore require coverage by Medicare,” he says. Then file an appeal when the claim is denied. Goldstein warns the appeals process is lengthy and that people should be patient.
The Medicare program has been tightening its proverbial belt after allegations of widespread fraud and misbehavior by a handful of DME providers. According to Susan Yascavage, billing supervisor for Norco Medical in Missoula, Mont., expenditures for DME only account for 2 percent of the entire Medicare budget. Nevertheless, she says Congress is looking at Medicare’s bottom line when they consider cuts or restrictions to the program. “Congress is looking at DME providers and the money they can save versus the human being that needs the product,” she says.
On the other hand, getting Medicaid to cover your bathroom equipment may be possible, depending on the state you call home. But many states are following the Medicare guidelines when it comes to Medicaid covering bathroom equipment. In Montana, Medicaid doesn’t cover equipment strictly for showering or bathing. They will, however, consider coverage for a high-end shower chair if you also use it for toileting purposes.
Medicaid varies greatly from state to state, but many Medicaid waivers will provide some funding for various kinds of adaptive equipment. You’ll have to check with your caseworker or state Medicaid office for coverage availability.
If you are a veteran, you may be eligible for a shower chair or grab bars under the Department of Veterans Affairs when it’s prescribed as being a necessary aspect of your care and treatment. The VA also offers a cash grant to qualified veterans with disabilities who wish to increase their mobility. The Special Home Adaptation grant can be used for any home improvement that helps veterans with service-connected disabilities increase mobility throughout their homes. Maximum grants are currently $10,000 and are available to veterans who have permanent and total disability as a result of military service.
There are many private insurance options available for bathroom DME coverage, but it depends on the policy you carry. Private insurance has no general rule for coverage, but they are another source that is trending toward following restrictive Medicare guidelines for DME decisions. “Some of the larger insurance companies are denying claims, treating them as a convenience and not medically necessary,” says Yascavage.
However, newer insurance providers seem to be more approachable if you need bathroom DME. “Some of the newer insurance companies that have come out in the last couple of years are saying yes, cover it, because there’s medical need,” she says.
Where to Get Bathroom Equipment
There are countless options for off-the-shelf bathroom/shower chairs and benches, but if you’re looking for low-cost products, your DME provider may not be the best choice. Visiting online retailers like Amazon, Walmart, Walgreens and 1800wheelchair.com will give you the chance to compare products and make the right purchase for your needs. However, if you need equipment that’s more durable or customized to your needs, there are a handful of companies you may want to consider for your next purchase.
SpinLife has a wide selection of shower/bath benches ranging from $95-$160. These benches all feature limited lifetime warranties and have weight capacities of up to 400 pounds. They also carry a limited number of tub sliders and more traditional wheelchair-style shower chairs. SpinLife features a live chat option during regular business hours and shipping is free on orders over $50.
Go! Mobility Solutions offers a range of portable tub sliders, stationary and roll-in shower chairs. All of their bathroom products require no tools or equipment for collapse and setup. “We have an everyday use chair that travels, so you don’t need one for home and one for travel,” says Goldstein.
The sliders and shower chairs the company sells start at $500 and top out at $2,100. Each seat is constructed from waterproof foam and each can support between 250 to 300 pounds. Optional accessories include headrest, side cut-out fillers, positioning belts, calf straps, commode tray, armrest extenders, backrest height extender and brake extenders. Go! Mobility Solutions also offers a 30-day free trial on every chair with no restocking fee for returns.
Another provider of portable bathroom equipment is Nuprodx. The San Francisco-based company features modular tub slider systems, stationary and wheeled shower chairs. “Our patented design uses a clamp so the legs clamp into the seat frame,” says Bruce Hammer, CEO of Nuprodx.
Nuprodx has a wide-range of tub sliders and shower chairs that range from $1,000-$5,000 and can support between 300 to 400 pounds. Their shower chairs fit over high toilets. They have numerous dealers across U.S. and Canada and their products are sold through National Seating and Mobility and Numotion. They can customize their products for a more comfortable fit and their products feature a three-year warranty. All tub sliders and shower/bath chairs are available for a 10-day trial, but there is a 10 percent restocking fee if returned.
Insurance coverage varies from state to state and is usually provided on a case-by-case basis. “The reality is that if the dealer writes a good letter of medical necessity and gets a prescription from a doctor who is willing to fight, you have a chance,” says Hammer. Nuprodx also has a contract with Veterans Affairs for insurance reimbursement on their products.
The most important thing to remember is to never give up. “You’ve got to be patient and at the same time aggressive in terms of filing for appeals, and don’t give up so quickly if the insurance company says no,” Goldstein says. Being persistent after being denied may prod your insurance company into making a favorable decision on your behalf. “If one person at your state level or at your insurance level won’t talk to you about it,” he says, “tell them you want to speak with the supervisor.”
- Centers for Medicare and Medicaid Services: www.cms.gov
- Department of Veterans Affairs: www.va.gov
- Go! Mobility Solutions: www.goesanywhere.com
- Nuprodx: www.nuprodx.com
- SpinLife: www.spinlife.com
Equipment Grants and Foundations
Securing a grant may be time-consuming, but it can be a good option to purchase equipment if your funding is limited. Many disability-related organizations offer grants for various purposes. You may want to check with organizations you’re affiliated with to see what they offer.
The Brighter Tomorrow Grant from the Multiple Sclerosis Foundation provides up to $1000 for equipment that improves quality of life by enhancing safety, self-sufficiency, comfort or well-being. Applicants must be diagnosed with MS and be over 18 or be the parent of a minor child with MS and have no existing financial coverage such as Medicaid or private insurance. For more info, call 888/673-6287 (MSFOCUS) or email email@example.com.
The Travis Roy Foundation offers grants for anyone who sustained a spinal cord injury from an accident. Applicants must specify a particular piece of equipment to be funded between $2,000-$5,000. To apply for the grant, visit www.travisroyfoundation.org/sci/grants/application/.
The Elsie Bellows Fund, operated by United Cerebral Palsy, provides grants for purchasing equipment that increases, maintains or improves the functional capabilities of individuals with disabilities. Applicants must demonstrate financial need and not have other funding resources. To learn about the Elsie Bellows Fund, email firstname.lastname@example.org.
Loan closets and organizations that recycle used medical equipment can be a no- or low-cost alternative to a costly purchase. They can also be great places to donate equipment that you’re no longer using. Equipment loan length can range from temporary to as long as you need something. The Muscular Dystrophy Association operates one of the largest equipment programs in the country for people with neuromuscular diseases. You can get more information about the program by calling 800/572-1717. For more organizations that can provide used equipment, please visit www.rmmor.org/nonprofits.htm.
One Quad’s Solution
It has been nearly four decades since Rick Goldstein became a quad after a diving accident at Tanque Verde Falls in Arizona, but he hasn’t let grass grow under his wheels. Despite having a traveling spirit, Goldstein soon discovered the difficulty of long trips. On shorter ventures, he could pack his non-portable shower chair into his van, but on longer stays when air travel was required, the choices were limited.
Goldstein searched for years to find a solution, to no avail. This changed nearly 10 years ago when he decided to purchase a so-called portable shower chair from the Internet for about $600. The chair was made out of painted steel tubing. It wasn’t long before he found a multitude of issues. “It was steel, it leaked all over my wife’s white carpet, and it was dangerous,” he says. Frustration began to build and he knew that he’d have to invent his own solution.
He set out to make the perfect chair that would meet his needs. “I don’t have an engineering background, but I’ve always been mechanically inclined and a bit of a tinkerer,” he says. He hired an engineer from the Mars Pathfinder Team at NASA, and after some work they ended up with a chair that was not only comfortable and lightweight, but more importantly, portable. “I never planned on going into business with it,” he says. “People saw it, liked it and said I want one.”
The development of his shower chair led to the founding of Go! Mobility Solutions in 2005. They offer a full line of shower chairs and tub sliders that easily pack into a travel bag. “If it doesn’t go into a travel bag, we don’t make it,” he says.
In 2008, Goldstein took another huge step when he applied for a VA contract so veterans could receive insurance reimbursement on his products. The process was a bureaucratic one, but he wasn’t intimidated. “It can be extremely frightening just to look at the paperwork involved,” he says. It took two years, but now his products are approved for VA coverage.
The Medicare and private insurance rules and regulations surrounding bathroom DME make absolutely no sense to Goldstein. “They