Medicare Games

I use a power wheelchair that Medicare rightly paid for some six years ago. Were I to need another one today I would be in for the fight of my life to get it.

That’s because Medicare has made some stealth decisions that the public has not been informed about. One such decision is to change eligibility criteria for power wheelchairs so that one must not be able to take even one step in order for the wheelchair to be “medically necessary.”

Imagine all the disabled people that approach will leave out. I know many people who can take a step but who cannot do that enough times to get themselves around in their homes or in their communities.

My friend Neil, for instance, has cerebral palsy. He can take a step and he can get in and out of his chair but without his chair he would not be performing as an actor in the theater.

Others with muscular dystrophy, some with post polio or multiple sclerosis can stand up and move around but cannot attend school, conduct meetings, participate in formulating disability policy, i.e. direct their lives, without a power wheelchair.

Medicare is busy at work denying people who have legitimate conditions power wheelchairs. One report described the travails of a nun whose doctor stated that arthritis in the knees made it impossible for her to take even a single step, yet Medicare had denied payment on her wheelchair! The company who provided the chair was left hanging with the cost of having purchased it with no reimbursement forthcoming from Medicare and the quandary of whether to sue the nun or not for the cost of the chair. (see Janofsky, Michael, “Costs and Savings in Medicare Change on Wheelchairs,” New York Times, Jan. 30, 2004)

The government complains that there has been a soaring demand for power chairs accompanied by soaring costs. No doubt this is so. More people who really need one *want* one. These days more elderly persons are ignoring the stigma of using a mobility device and instead are determined to get around better. They are realizing that rather than being confined to a bed or a room, powering around in a chair gives them freedom to continue to have an active life. Medicare-provided technology brings greater quality of life.

On a human level the social need should rate at least equal (if not higher) to the medical need. Medicalization may be inappropriate in such evaluations but Medicare is a medical model institution so I’ll leave that for another discussion.

Medicare officials are alarmed at the cost of this increased demand for power chairs and have decided to clamp down on paying for them in the name of fraud and abuse control.

Truth is there is fraud. There is always fraud in any benefits program, but Medicare is not just weeding out fraud. Medicare, or specifically the Center for Medicare and Medicaid Services (CMS) under the supervision of the White House, has imposed these new limitations on who can get a chair. One supposedly cannot be capable of taking one step but even then Medicare may not pick up the tab as in the nun’s case above. In short disabled people are the ones getting squeezed by this strategy of denying legitimate reimbursement to “save” millions of dollars.

Tightening eligibility requirements won’t hurt rich disabled persons because they will be able to pay for a chair out of pocket. It will, however, be devastating to people on fixed incomes in the middle and low end of the income scale. Without a power chair and unable to do for themselves, they will be crawling around in their homes or become $fodder$ for the nursing homes. Lives are often compromised in nursing homes that provide negligent “care.” Think about yourself in such a situation!

Medicare is playing games with beneficiaries’ lives. The present situation reads like the days of Reagan when the mean spirited at the helm threw disabled people off disability benefits. Many people cut off benefits died due to Reagan’s Social Security policies.

Here is another game Medicare plays. I go to see a chiropractor regularly who alleviates a great deal of my myofacial pain syndrome and keeps me productive. There is no limit on the number of chiropractic visits per year under Medicare rules. Medicare has been paying for those visits until late last fall when it stopped paying without warning. Instead of a check for the 5 end of the year visits the corporation contracted to handle Medicare billing sent my chiropractor a letter requesting a “treatment plan” and chart notes documenting each visit.

My chiropractor runs a small office so the extra paper demand was heavy for him to bear, especially since the reimbursement Medicare pays is so low. He did, however, put what they requested together and mailed it back to the National Heritage Insurance Co., the private corporation that oversees Medicare reimbursements for my area.

It took well over 30 days before he heard anything back from them. When he did, it was another letter just like the first one asking for chart notes, etc. as if he had sent nothing to them! Follow up phone calls did nothing to clarify the status of his invoices.

I suspect this is a game Medicare is playing to dissuade him from seeking payment. It may even be geared to dissuade chiropractors at large from taking Medicare patients at all.

This suspicion was grounded when my chiropractor said he had recently attended a trade conference where other chiropractors were talking about Medicare playing hardball by making them do extra paperwork and not paying them for visits promptly as they should (or at all).

Nonpayment may be the going trademark for Medicare these days. My wheelchair repairman told me he was having a hard time getting reimbursed for fixing Medicare wheelchairs. Indeed, Medicare’s credit has become so bad that I must now pay cash to see the chiropractor.

If the medical equipment suppliers and our providers cannot get reimbursed then we become liabilities in the multi-level medical maze under capitalist medicine.

Moreover, denial of needed equipment means social isolation for and degradation of disabled persons. It is a perfect illustration of the impairment causing disability – disability being the socially imposed state of exclusion impaired people are often forced to bear.

These actions on the part of Medicare oppress disabled persons by stripping them of the ability to live full lives. Medicare is becoming a disablist health care system – unreliable, often delivering social death rather than optimal life.

— Marta Russell Los Angeles, CA http://www.martarussell.com/

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