05/04/2024
Day 5, Week 1:
**Retail vs Insurance** Discussion of Pros and Cons
When it comes to obtaining mobility aids like wheelchairs, scooters, powerchairs, walkers, or other equipment, individuals often face a choice between purchasing retail (out-of-pocket) or going through their insurance provider. Each option has its own set of pros and cons, influenced by factors such as cost, selection, and timing. Here's a breakdown to help guide your decision:
# # # Retail Purchase Pros:
1. **Immediate Access:** When you buy directly from a retailer, you can often get the equipment immediately or within a few days, depending on stock availability.
2. **Wider Selection:** Retailers typically offer a broader selection of models and brands, allowing for a CHOICE that best fits personal preferences, needs, and lifestyles.
3. **No Need for Approval:** Buying retail eliminates the need to navigate insurance approvals, which can be time-consuming and sometimes frustrating.
4. **Flexibility:** You have the freedom to choose higher-end models or specific features not always covered by insurance.
# # # Retail Purchase Cons:
1. **Upfront Cost:** The most significant downside is the cost, as purchasing out-of-pocket means paying the full price verse insurance paying on your behalf.
2. **Lack of Coverage for Repairs/Replacements:** Without insurance, the costs for repairs, maintenance, or future replacements fall entirely on the individual. Most manufactures have warranty for manufacturing defects but similar to an automobile, once purchased the owner will pay for repairs.
# # # Insurance Purchase Pros:
1. **Cost Reduction:** Insurance can significantly reduce the personal financial burden, covering most if not all of the cost of the equipment. Very dependent on allowable and medical need.
2. **Warranty and Repairs:** Insurance-covered equipment often comes with a warranty, and repairs or necessary replacements may be covered. This is becoming more difficult because most repairs are less than $500. It is difficult to find a provider willing to do all the leg work required for low dollar repairs.
3. **Professional Assessment:** Insurance processes typically require a professional assessment, ensuring that you receive equipment that truly fits your medical needs.
# # # Insurance Purchase Cons:
1. **Limited Choices:** Insurance providers may have contracts with specific manufacturers or suppliers, limiting the selection of models and features available to you. Low reimbursement rates, reduce the product availability.
2. **Approval Process:** Obtaining approval can be a lengthy process, involving lots of paperwork and possibly long wait times.
3. **Possible Denials:** There's always a risk of denial for certain models or features that the insurance deems non-essential, requiring appeals or out-of-pocket payment anyway.
In summary, the choice between retail and insurance for purchasing mobility aids hinges on individual priorities like budget, specific needs, and how quickly the equipment is needed. Retail offers more control and immediate access but at a higher cost, while insurance can make mobility aids more affordable but often with more restrictions and a slower process. Consider these factors carefully to decide which path aligns best with your needs and circumstances.
As discussed earlier this week, insurance carriers only have one reimbursement rate for a medical code. Here I’ll use an example for a scooter, K0800. Some insurance carriers reimbursement rate is under $500. It is very difficult today to find a scooter whose manufacturing cost and freight is less than $500. For a provider, they need to acquire the product on behalf of the patient and several hours of leg work with the physician and insurance carrier to get the equipment approved. Since this funding is $500, there are no scooter manufactures that have FDA approval and listed on the PDAC website with a cost less than $500. Because of this, most providers will not process a K0800. The alternative is a K0823, which is a powerchair. Powerchairs are easier to maneuver in the home and have more battery power than a scooter. The difficulty is the doctor MUST rule out a scooter to get qualified for a powerchair. Additionally the K0823 is a 13 month rent to own so there will be co-pays across 2 years and if there is a change in insurance the product must be returned.
Next week, I will be covering an introduction to mobility equipment. See agenda for next week below
Week 2: Introduction to Mobility Equipment
• Day 1: Understanding Mobility Issues – An introductory post about common mobility issues, highlighting how different equipment can help.
• Day 2: Spotlight on Scooters – A detailed post on the benefits of medical scooters.
• Day 3: Powerchair Advantages – Focus on powerchairs, their features, and how they differ from scooters.
• Day 4: Video Demo – Share a video demonstration of scooters and powerchairs, showcasing ease of use and features.
• Day 5: Personal Stories – Share stories from real customers who have regained independence through our products.
please like and share with family and friend that need mobility equipment for more independence with daily activities.
