Getting your first power chair can be a demoralizing process — at best you get to pick the color. Even well-meaning therapists and providers often don’t know what to expect. Until you have used it for a while, you can’t know how a power chair fits into your life. It’s then that you learn what works and what doesn’t, what you want and what you don’t — the good, the bad and the indifference of power chair use. When the time comes for a replacement, you know much more about what you need and what you want.

Still, the process of moving up to your second power chair isn’t seamless. Knowing how to systematically approach selection exponentially increases the success of your comfort and mobility. All may not have been right with that first power chair, but with the right approach, your second power chair gives you a second chance at perfection.

Rules of Replacement
First, when are you eligible for a new one? It is a common misconception that you become eligible when your first chair is five years old. While it is true that power chairs must be built to last five years per regulatory durability standards, the actual policy that virtually all insurers follow for replacement is either need-based (change in medical condition), or the power chair is so worn that it’s less costly to fund a new power chair than repair the old one.

For example, let’s say your power chair is only three years old, but the basic seating and features no longer meet your medical needs. You most likely qualify for a new power chair. Similarly, if at four years your power chair is dilapidated beyond reasonable repair, you may qualify for a new power chair. Your medical needs and/or the power chair’s condition take precedence over the calendar date.

“First power chairs are tricky,” says George Turturiello, assistive tech professional and certified rehab tech specialist, a 20-year veteran of the mobility industry. “As much as everyone tries to get it right, not all experiences or changes in condition can be foreseen. As the user, if you have a change in condition or your power chair isn’t serving you as it should, let your therapist or provider know. A new power chair may be needed to protect your health and independence.”

Becoming a Power Chair Pro
“The second power chair is a time to get it right if the first power chair didn’t,” says Turturiello. “The more a consumer knows about both his or her needs, as well as the technology going into the process, the better the final outcome.”

Start by making a two-column list of what your first power chair does really well and any improvements you would like to see in comfort, features, performance and safety. Now that you’ve given your mobility more thought, do a little window shopping via the Internet. Not only are power chair manufacturers’ websites great resources to browse, but so is YouTube for related videos. Also, check out disability-related online communities for other consumers’ experiences and feedback. Along the way, you almost certainly will learn attributes of power chairs that will help refine your list.

“The saying holds true — an educated consumer will be a satisfied consumer,” says Turturiello. “The more self-understanding of your needs and wishes you can bring into the process of getting your second power chair, the more satisfied you’ll be with the result.”

Understanding the ‘Rx’ Process
It’s not uncommon for those receiving their first power chair to not fully know the protocol involved. Furthermore, the funding process has changed in recent years. In moving toward your second power chair, it’s important to know the steps involved and where to begin.

First, a face-to-face physical exam and diagnosis by your physician is required. This is where your physician notes any changes in your medical condition. If there are medical needs that specifically relate to needing a new power chair — for example, you’re finding you are at risk of pressure sores because you can no longer shift your weight — describe that, as it can help justify seating options.

“It used to be that a physician could simply write a prescription for a power chair,” says Turturiello. “However, now a much more thorough exam and chart notes must be taken. The goal is that the better the medical exam and documentation, the better the fitting of the power chair.”

Next, a “Specialty Evaluation” is required. This can be done by the physician if he or she knows complex rehab technology. If not, then it must be accomplished by a physical or occupational therapist. During this evaluation medical necessity is aligned with mobility technologies. If there’s an independent living skill or activity that you wish to accomplish with your new power chair, now is a great time to bring it up.

“During the Specialty Examination, you should discuss how your current power chair is not meeting your needs and what activities of daily living you seek to pursue with a new power chair,” says Turturiello. “For example, maybe your first power chair was a rear-wheel drive and couldn’t turn in your bathroom. Getting a mid-wheel drive that turns in a smaller footprint may resolve that. So, really consider both your medical and in-home needs, and express them.”

After the Specialty Examination, the “7 Element Order” must be completed by the physician. This takes into account both the medical and Specialty Examination. It includes your name, description of item that is ordered (“Power Wheelchair,” or an even more specific description), date of completion of the face-to-face examination, pertinent diagnoses and conditions that relate to the need for the power chair, length of need, and the physician’s signature and date.

Once the medical documentation is complete, your selected provider (commonly called a DME or dealer), who must be a certified assistive technology practitioner, works with you to configure and specify exact technologies. This is the stage where you try different models of power chairs and select features. At this point, a required “Home Assessment” is performed to ensure a power chair’s compatibility with your home environment. This can technically be done at any point, including time of delivery.

“Never assume a power chair will work in any given space or environment,” says Turturiello. “The same goes for features. It’s so important to demo a power chair in the spaces and environments you will use it in. It’s wiser to get the right power chair through a proper evaluation process, rather than end up with a power chair that, like the first, doesn’t meet your needs in every way.”

After you’ve trialed power chairs, explored features and options and made your selection, a “Detailed Product Description” (the literal line-item wheelchair order) is sent to the physician for a signature, then returned to the provider. Once the insurer processes the claim, in a month or so your new power chair is delivered.

Covering What Insurance Doesn’t
In ordering your second power chair, you’re likely going to want features that may not be covered by insurance. For example, most insurers don’t fund elevating seats, lighting or high-speed motors. Yet, these features may be important to your independence and safety. Fortunately, most insurers, including Medicare and Medicaid, allow you to pay for non-covered items and features out-of-pocket. However, it must be properly documented and is most often paid for at the time of purchase with a legal document called an Advance Beneficiary Notice. Providers are used to going by what insurers approve, so if there’s a feature you want that’s not approved, discuss out-of-pocket options if you can afford it.

Even if you have been frustrated by your first power chair, approaching the process of getting your second one with enthusiasm is important. It is, after all, an opportunity to improve not just your mobility, but also your life. By understanding your needs, the technology, and the prescription process, you won’t just be ahead of the curve, you’ll be more in control of it. It’s that control over your mobility decisions that will ultimately empower you in your life, no matter what directions you choose to travel.