Guest blog post by Bob Vogel
My previous column, The Importance of Back Support in Overall Health With SCI, discussed how crucial proper back support is; having a positive effect on everything from pressure reduction in the lower pelvis—meaning reduced risk of pressure ulcers—better posture, reducing or eliminating back and neck pain, healthier shoulders, to improved breathing. This column is about how get the proper back support, including how to get it funded.
“There are a couple ways to go about getting the proper wheelchair back,” explains Tricia Garven, PT, ATP, Clinical Applications Manager at The ROHO Group. A rule of thumb is to have your wheelchair back evaluated each time you replace your wheelchair cushion—every three years, which is how often most insurance and funding sources will pay for a new cushion—something I wrote about last year in “How Often Should You Replace Your Cushion?”
The steps on how to get properly evaluated for a wheelchair back and cushion (seating evaluation) start off with you being the squeaky wheel—you need to speak up and ask. One way to start the process is to tell your physician you are due for a new cushion and ask for a referral to a seating clinic for a seating evaluation with a clinician—a PT (physical therapist) or OT (occupational therapist).
Another option for getting the process started is to contact your local DME (durable medical equipment) supplier and tell them you need a new cushion and require a seating evaluation to see if changes are needed in your current wheelchair back and/or cushion — they will be happy to guide you through the step-by-step process of getting the wheelchair back and cushion based on your seating needs.
If you don’t already have a working relationship with a DME supplier, locating one is your next step. ROHO makes this easy. To find a DME supplier go to www.therohogroup.com/where_to_buy.jsp and click on Buy from an Authorized Retailer Near You.
You can find Medicare DME provider(s) in your area by going to www.medicare.gov. Pull down Resource Locator on the main page, scroll down to Medicare Supplier Directory; from there type in your zip code and hit submit. On the next page check Wheelchair Seating/Cushions and hit View Results. The “default” setting on View Results is 10 miles — to find more DME supplier options it is helpful to expand the View All Suppliers Within (on the right side of the page) to a larger distance in order to find a Medicare DME provider that is also a ROHO authorized retailer.
Once you contact a DME supplier, be sure to ask the person working with you if they are an ATP (Assistive Technology Professional) and/or SMS (Seating and Mobility Specialist. These are credentialed professionals trained to identify postural (proper posture) and seating issues and have the knowledge to provide the appropriate back support and cushion solution to address your seating needs. The ATP and/or SMS will gather your information, current wheelchair, wheelchair back, cushion, insurance information, etc. They will contact your physician and get a referral for a clinician to do your seating evaluation, or they can do the seating evaluation themselves.
The goal of a seating evaluation is to find out if your present wheelchair back and cushion is still appropriate, or whether your body has changed that may require an adjustment in your wheelchair back and/or cushion. “In order to make sure the back support is addressed during the evaluation, it is important to communicate with your clinician,” explains Garven. At the beginning of the seating evaluation, ask the clinician, “How does my posture look? Does it look like my seat back is providing the proper support? Would an aftermarket solid back improve my seating?”
Garven explains that changes in posture are gradual and can cause many problems including skin issues and reduction of function. During a seating evaluation it is important to tell your clinician if you have any redness or skin issues in the seated area of your pelvis, or back pain, or shoulder pain, or neck pain, or if you are finding it more difficult to push up hills or over small threshold—all of these are indicators of possible changes in posture. These changes can often be addressed and improved by proper back support. Garven explains that while most clinicians will put two and two together and look at back support as a way to address these issues, it is important for you to speak up and ask, “Is this something that additional back support can help?”
Most seating evaluations should include trying different wheelchair backs to ensure proper back support. As an example, if somebody needs more posture support than their standard sling back provides, a clinician would put a ROHO® AGILITY™ Mid Contour Back System on their chair to see if it improves their posture. When a wheelchair back maximizes posture and your function, the clinician has a match. Following the seating evaluation, the clinician takes the information and writes a Letter of Medical Necessity to submit, along with a doctor’s prescription to the insurance company for the wheelchair back and cushion.
Sometimes circumstances require getting a new back support before it is time to get a new cushion. Garven explains the sooner a posture issue is identified and addressed by proper back support the easier it is to correct. “Anytime you have issues that may be related to postural changes, like back pain, skin redness, shoulder pain, neck pain, trouble getting up hills or over small thresholds. You should bring this up with your doctor and ask if it may be a postural issue and ask for a referral to a seating clinic for a seating evaluation to look at a back support,” she says.
When it comes to funding wheelchair backs, Dave McCausland, Senior VP of Planning & Government Affairs for The ROHO Group explains that wheelchair backs are coded under Medicare (meaning they will be reimbursed with the proper documentation) and since Medicaid and private insurance companies tend to follow Medicare’s guidelines, he is confident that most will cover wheelchair backs as well.
Garven explains that the steps to get funding for wheelchair backs are the same as they are for cushions. That is, a Letter of Medical Necessity and a doctor’s prescription–like any custom mobility product, it is extremely important to make sure the exact make, model and manufacturer is on the Letter of Medical Necessity. For example, the Letter of Medical Necessity would include:
ROHO AGILITY Mid Contour Back System, 14“.
This ensures that your new wheelchair back is exactly what you tried, need and expect. Although an ATP and/or SMS will know this, in order to get a wheelchair back funded, it is important that the Letter of Medical Necessity describes your “significant postural asymmetry” which is funding terminology for not sitting in a proper upright position, along with your diagnosis.
From there, the team gathers and organizes all the documentation. Then the DME supplier submits the paperwork to the insurance company for approval. If all goes well, your back (and cushion) is ordered and you receive the proper back support and are soon sitting up straighter, and looking and feeling good!
Bob Vogel, 51, is a freelance writer for the ROHO Community blog. He is a dedicated dad, adventure athlete and journalist. Bob is in his 26th year as a T10 complete para. For the past two decades he has written for New Mobility magazine and is now their Senior Correspondent. He often seeks insight and perspective from his 10-year-old daughter, Sarah, and Schatzie, his 9-year-old German Shepherd service dog. The views and opinions expressed in this blog post are those of Bob Vogel and do not necessarily reflect the views of The ROHO Group. You can contact Bob Vogel by email at email@example.com.