How I Got Medicare to Pay for My SmartDrive MX2


Imagine entering an ice cream parlor, ordering a large chocolate banana split, and receiving a giant steaming hot bowl of turtle soup instead. You’d likely be quite confused! When I tried to purchase an ultra-light wheelchair, with a SmartDrive MX-2, I had an equally odd experience. OK, so it wasn’t a bowl of turtle soup, but I knew what I ordered, and the vendor repeatedly tried to give me something else — like a full power chair.

Not My First Medicare DME Rodeo!

One of my strengths is the ability to identify and articulate my needs, and as it relates to purchasing durable medical equipment, this was hardly my first rodeo. Two of my family members were non-ambulatory, and in the ’70s, I worked as a vocational nurse. Later in life, my career shifted into medical technology, where I learned that purchasing new technology through Medicare sometimes posed challenges.

So, in 2015, after a fall (actually two falls in one day) resulted in one broken ankle, and another sprained ankle, I was fully prepared to go from being a part time wheelchair user, to a full-timer and knew the SmartDrive MX2 was best for me. My doctor, who considered my diagnosis, prognosis and extensive fall history, apparently agreed and wrote a prescription for an ultra-light wheelchair, with a SmartDrive MX2.

One would think that with a written prescription, a qualifying disability, a drastic change in medical circumstances and Medicare with a generous supplement, it wouldn’t be difficult to place the order, but nothing could be further from the truth. Each one of the six equipment vendors I contacted looked at me like I had three heads, and insisted that “it wasn’t going to happen,” and because I qualified for a full power chair, suggested I should “be more agreeable and accepting” of that.

Now, for an almost 60 year old woman, I have abnormally strong triceps, and refuse to give them (or anything else) up. When I’d explain that, they all had the same response: “OK, we can get you a lightweight manual chair without a SmartDrive, and after two years of being a full time wheelchair user, we can try to get you a SmartDrive.” I explained that both the back rest and axle on a standard wheelchair are wrong for me, and that my biceps and shoulders are not able to propel me on inclines or carpet, but their response was to revert back to pressuring me into a full power chair!

Two Steps, Maybe Three

Like I said, this was not my first Medicare DME related rodeo! I knew Medicare would only pay for a chair once every five years (or more) so this was my only shot to get it right the first time. Given my prior experience in the medical technology industry, I knew there were two basic steps in obtaining the best outcome for any situation:

Ask the best question.

For example, if I asked, “Why can’t I have ice cream?” most people would respond with a zillion reasons why not. A better question is “What can I do to acquire some ice cream?” Clearly, as it relates to my wheelchair, step one did not work, so I moved on to step two.

Understand the value of asking the proper person for your question.

In this situation, I had expressed my needs (including a qualifying diagnosis) to the DME vendors, but I was still getting the same response. This is where I discovered the need for step three!

Refuse to settle for the wrong answer!!!

Why would anyone in their right mind accept turtle soup when they ordered ice cream? It doesn’t matter who’s picking up the tab if YOU are the one who’s going to be eating the proverbial ice cream! This is YOUR wheelchair, based on YOUR needs and YOU are the one who will live with it!

The Challenges

Because I had paid cash for my part-time manual wheelchair years earlier, Medicare had no record of it, and from their point of view I must not have used one at all, ever. Meanwhile, with two badly injured ankles, I could not ambulate at all, nor could I propel my manual chair full time.

I clung to step three and to get through the short term, purchased a used mobility scooter for cash. Out of fear they’d then insist on a scooter, which in the long term would further compromise my already limited shoulders, I flat out lied and denied having one.

It took nearly a year for me to figure out what to do next, and by that time, with the help of a walker, I was hobbling around again, however, I was still prone to falls resulting in an occasional ER visit (which ironically cost more than the SmartDrive).

The Solution

As the saying goes, “the definition of insanity is doing the same thing over and over again, and expecting a different result.” Having exhausted steps one and three, I revisited step two and realized my local vendors were not the proper people to help me obtain my chair. In desperation, I phoned Max Mobility directly to explain my situation.

Now, I don’t recommend starting this process by calling the manufacturer, they have better things to do (like invent better wheelchairs), but in this case, I needed a functional wheelchair, and didn’t want the wrong chair for the next five years!! I also knew that if I settled for a full power chair, it’d be unlikely (based on the nature of my disability) that they would downgrade me to a partial assist in the future. All I wanted was to find someone who would attempt to order it, and if declined, I would at least have the option of filing an appeal with Medicare!

Max Mobility listened, and kindly sent out a sales representative who had experience selling the SmartDrive to the Medicare consumer. With the help of my primary care physician, and their representative, we were finally able to order my chair! We didn’t need to file an appeal, and within a few months, my wheelchair finally arrived — and with the added bonus of the MX2+ which allows for an all power and acceleration option. Personally, I prefer the MX2 in hopes of keeping my triceps cut, but the option of the MX2+ is nice to have.

Bottom Line

Purchasing a wheelchair is an extremely individualized process. You, the end user, quite likely know better than anyone what is best for you. If it is your first wheelchair, shop around, test drive a few, maybe even buy a used one or rent it for a few months. If it is not your first wheelchair, I’d suggest trying my formula; ask the best question, the right person, and of course, refuse to settle for the wrong answer!

Written by of New Mobility