Most private health insurance carriers and state Medicare or Medicaid programs do not cover transportation to wheelchair evaluation or repair appointments. Coverage that does exist varies widely by state and provider. If CRT appointments are covered under non-emergency medical transport (NEMT) provisions, health insurance carriers often set specific medical necessity requirements that CRT users must meet. In many cases, a healthcare provider must make the request for transportation and provide documentation that it is medically necessary. 

Educate Yourself: To learn more about what’s included or required in your state’s Medicaid program, please reach out to your state’s Department of Health and Human Services or comparable department. Find your state’s department here. If you’re covered by a private insurance carrier or Medicare, reach out to your insurance carrier for more information on what types of transportation may or may not be covered under your plan and the process for using those benefits to cover transportation to your CRT branch appointments.  

How Would Covering Transportation Help CRT Users? 

When it comes to CRT equipment, there’s no “one size fits all.” Each mobility device is highly customized to meet each individual user’s specific needs. A customized manual or power wheelchair can consist of a variety of individual components—all of which require frequent adjustments and repairs since CRT equipment is used on a daily basis. Because of this level of customization, many repairs need to be made by certified technicians. If CRT users can’t travel to their wheelchair provider for an appointment, the technician will come to them. 

Data tells us that 85% of repairs are completed in the home, and in-home repairs are always an option, especially for CRT users who are unable to travel due to their condition or other factors. But if you choose an in-branch appointment, there are benefits including:  

• In-branch repairs give technicians access to more parts than can be stocked on a van as well as specialized equipment/tools and the space needed to complete complicated repairs. 
• If an additional repair or maintenance need is discovered, the technician may be able to complete them without scheduling a follow-up appointment. 
• Technicians can see more CRT users in a day and serve them more quickly. 

If Medicaid, Medicare and private health insurance carriers covered wheelchair evaluation and repair appointments under their NEMT provisions, more CRT users would have access to their local branches for CRT-related appointments, protecting their health, preserving their independence and helping to keep their wheelchairs in optimal working condition.

Did You Know You Can Make a Difference? 

As a CRT user, your experience can help legislators and health insurance carriers see the need for change. Here’s how you can help: 

Pay It Forward: If you are able to travel to a local branch for a repair appointment, please consider doing so. This often results in a quicker repair timeline for you and allows technicians to prioritize CRT users who cannot travel due to diagnosis, condition or other factors with in-home appointments, ensuring everyone gets the help they need as quickly as possible. 

Share Your Story: Reach out to your state’s health and human services department and elected officials at both the state and federal level and explain how accessible transportation policies affect you. Find your elected officials. 

Make Your Voice Heard: Contact your health insurance carrier or Medicaid advisory groups. Call the Centers for Medicare and Medicaid Services (CMS) directly at 1-800-633-4227. 

The post Did You Know: Transportation Coverage appeared first on NSM — National Seating & Mobility.

When your complex rehabilitation technology (CRT) equipment breaks down, getting it repaired as quickly as possible is critical. Your chair is what keeps you moving through life. 

But CRT repairs take time. Many factors influence the repair timeline—from insurance documentation requirements to the review and approval process—and a lot of them are outside of the CRT user’s control. Even so, there are some proactive steps you can take to help keep the repair process moving as quickly as possible.

How Can You Help Speed Up the Repair Process?

Tip 1: Report the problem BEFORE it becomes catastrophic. 

Joystick not working properly? Notice a problem with your tire, footrest or battery? Report the issue to your CRT provider as soon as possible so that a small problem doesn’t become a full breakdown. Your wheelchair provider will set up an evaluation to determine what’s causing the problem. In some cases, a technician may be able to perform a remote evaluation, but if that is unsuccessful, you may need to schedule an in-branch or in-home evaluation appointment. 

Tip 2: Understand insurance requirements and approval times. 

Data tells us that almost 45% of the repair process is spent collecting documentation and waiting for insurance approvals, making this one of the most time-intensive parts of the process. Before parts can be ordered or repairs begin, most insurance carriers require prior authorization, which usually includes a repair evaluation and estimate as well as documentation of medical necessity and other requirements. 

You can help the process along by: 

• Understanding what documentation your insurance carrier requires. Learn more about common documentation requirements and seek to understand who is responsible for each, so you know who to contact if something is missing and can help urge them to quickly provide the required documents.  
• Reach out to your insurance carrier during the process to ensure the required documents have been received. 
• As the policyholder, request an expedited review of your documents, stressing that it is important that a decision be made quickly. 
• Keep copies of all the documentation you, your physician, or wheelchair provider have submitted to your insurance carrier and record when those documents were submitted.

Tip 3: Describe the problem as clearly as possible. 

When you reach out to your CRT provider for a repair evaluation appointment, strive to explain the issue as clearly as you can. State what part or parts are affected, what is or isn’t working, when the issue started, and if it’s gotten worse over time. 

Other advice: 

• Want your technician to see what you’re dealing with? Take a quick video when the issue occurs so that you can show them the problem and how it’s affecting your daily life. 
• Take photos of any damage or wear and tear that may help the technician diagnose what’s wrong with your CRT equipment.

Tip 4: Keep a maintenance log. 

Your CRT equipment needs to be in top working order to ensure you can achieve the highest level of mobility and independence you desire. Keep track of repairs and previous problems so you’re well informed about what’s been tried before and what hasn’t. Your records can help add additional information and details to those your technician and wheelchair provider have on file, helping them make an informed diagnosis as quickly as possible. 

Tip 5: Stay informed about your order. 

Seek to keep track of your order as it moves throughout the process. Many CRT providers, NSM included, offer online order tracking that helps you stay informed. If you are an NSM client, you’ll simply need to submit your first and last name and order ID at mynsmorder.com to track your order. If you don’t have your order ID, please email NSM’s customer care team at info@nsm-seating.com to retrieve that information. 

Keep in mind that CRT equipment is comprised of thousands of parts. While CRT suppliers keep a large supply of parts, they can’t feasibly stock every part that might need to be repaired. If a part needs to be ordered, it can add a little time to the process. By staying in touch and asking for updates, you help ensure the lines of communication stay open throughout the process. 

Take Action

Most insurance carriers require prior authorization for many (and sometimes, all) repairs. Often, this includes submitting a prescription and/or statement of medical necessity to prove you need the mobility equipment, even when the equipment was previously approved. 

Educate Yourself: Seek to understand your health plan’s prior authorization requirements and note how the prior authorization process slows down a needed repair. NSM completes more than 100,000 repairs each year and receives payer approval for more than 93% of them, meaning that prior authorization may not be necessary on most repairs. If prior authorization were removed for repairs under $1,500, it could help speed up the process by one to four weeks.

Connect with Advocacy Partners: Legislation is already under consideration in some states to remove prior authorization for some repairs, or if the mobility equipment has previously been approved by an insurance carrier as medically necessary. Connect with advocacy organizations like NCART, iNRRTS, AAHomecare, and other advocates to stay up-to-date about ongoing efforts and learn what is happening in your state.

Share Your Story: If legislation concerning the elimination of prior authorization is being considered in your state, reach out to your elected officials and share how this change would improve your daily life. 

The post Five Tips to Help Speed Up the Repair Process appeared first on NSM — National Seating & Mobility.