The Trails and Travails of the Wheelchair User

All wheelchair joysticks are powered by electrical circuits which means that any contact with water will kill the circuits. The water can be from any source such as water spilled using the sink, from garden sprinklers, from people washing their cars, and of course the rain.

Another factor is the enormous weight of the wheelchair and its drive wheels which means they ideally require a solid surface for driving. An empty wheelchair weighs anywhere from 200-500lbs. They have one set of drive wheels and two or two sets of caster wheels (usually 4-6″ wide). A number of issues can arise without a steady solid surface to drive on like when navigating curb cuts. Rain puddles at the bottom of the curb cuts can be deep enough to short out the power at the bottom of the chair. Rain puddles could also mask deep holes in the surface of the road where it joins the curb cut, Snow too could mask out the location of curb cuts as well as create an icy block which makes a curb cut unusable. To top it all dirt and debris could build up on the bottom of the curb cut making the curb cut unusable.

The repair process for a non-operational power wheelchair could take anywhere from a shocking 33 days to 55 days leaving the user without a wheelchair in the interim.

Depending on insurance, for people on Medicare the cost of DME (if covered at all) is 80% paid by insurance and 20% paid by customer. If you have Medicaid/MediCal then the 20% may be paid by them. Most insurance companies will not allow you to have two wheelchairs at the same time, so you’re not allowed to have a backup chair and they won’t lend you a loaner chair while your chair is being repaired.

Breaking down the repair timeline further underlines the careless disregard for the human user in the process – a human who depends on this very device for mobility.

▶︎ 1 — Insurance companies make agreements with specific wheelchair repair businesses. Wheelchair customers are required to use those companies in order for insurance to pay their part.

▶︎ 2 — The customer contacts the designated wheelchair repair business and asks for repair. (1 day)

▶︎ 3 — The wheelchair repair company schedules an appointment for wheelchair technician to ‘evaluate’ the problem. Customer self-reporting is never considered a reliable source of information. (7 days)

▶︎ 4 — The wheelchair technician documents the problem. (1 day)

▶︎ 5 — The wheelchair repair company submits a request for parts & labor authorization based on wheelchair technician’s report to the insurance company. (1 day)

▶︎ 6 — The insurance company looks up the code for the requested wheelchair repair and also the code for coverage of the customer. (7 days)

▶︎ 7 — If the insurance company determines that the requested wheelchair repair and the customer are covered, they notify the wheelchair repair company of specifics of authorization to pay. (1 day)

▶︎ 8 — After authorization is received, the wheelchair repair company submits the order for needed parts. (1 day)

▶︎ 9 — When parts arrive, the wheelchair repair company calls the customer to schedule a wheelchair technician to perform the repair. (7-14 days)

▶︎ 10 — The wheelchair technician goes to the customer’s home to perform the repair. About 50% of the time, all the needed parts are not there so the repair cannot be performed. (7 days)

•••▶︎ Wrong or missing parts: Steps 8-10 repeat as often as needed.

▶︎ 11 — When all parts are present and the wheelchair repair technician is competent in doing the repair, then the wheelchair is functional again.

Essentially:
Total days without working wheelchair (best case scenario): 33 days Total days without working wheelchair due to missing parts: 48-55 days.

Since most insurance will tell you that you’re not allowed to have a backup chair and they won’t lend you a loaner chair, what are you supposed to do?

Wheelchairs are meant to be mobility devices, but counter-intuitively not manufactured for outdoor use.

All manufacturers of wheelchairs design them for indoor use only.

This disconnect comes out of the basic medical model thinking. A person in a wheelchair equals a sick person. Sick people do not take care of themselves or others. Therefore, there is no need for these sick people to leave home. But this thinking ignores the fact that the vast majority of non-institutionalized wheelchair users have no paid help at all. So they have to not just take care of their own grocery shopping but also get to medical appointments on their own. Thus, having an indoor-only wheelchair creates enormous problems as well as significant personal risk when these “indoor wheelchairs” are used outdoors due to the sheer necessity of daily living.

Insurance companies are only required to provide a (single) power wheelchair capable of moving around inside a home. There is no requirement that the wheelchair must be able to work outside the home.

Wheelchair models and features

Insurance controls the type of wheelchair the user gets. The companies also have pre-set formulas for which features are included or not. These features include footrests, armrests, joystick type, swing-away base for the joystick, types of tires (inflatable or no-flat), tilt and//or recline function, battery type, motor type, etc.

Even within the formula, Medicare only pays 80%. People who live on SSDI ($1,000/month) will never be able to afford the 20% co-pay on a $30k wheelchair. So while there is technically coverage for a wheelchair and repairs, functionally, there is not any useable coverage at all.

SO, WHO BENEFITS?

There is irony in the current system. Though it is supposed to be about helping people with mobility, instead it primarily benefits from the profit margins for medical equipment vendors and insurance company bottom lines.