Patient lift recliners provide a safe way to transition from sitting down to standing. These recliners can help people who have difficulty getting up from a typical armchair. Patient lift recliners use a motor to slowly tip the user toward standing, removing pressure from the lower back and knees. However, a good-quality lift chair can cost upwards of $1,500 to $2,500. Most families want to know if their insurance company will help with some of this expense. After researching we were able to learn about how each of the big insurance companies assist patients who require a lift chair, including which hoops you need to jump through and other alternatives you could use for temporary home health equipment.
Short answer: insurance can pay for the lift mechanism – not the whole chair.
A critical point to understand upfront: in nearly every case — insurance companies do not pay for the whole chair. From an insurance standpoint, a lift chair has two separate elements combined together into one unit of furniture:
The motorized base:
this refers to the electrically operated foundation of the lift chair. Insurance companies consider this Durable Medical Equipment (DME) since it provides a clear medical benefit to the insured.
The Furniture Component:
this represents the actual seat, legrests, backrest, arms, cushions, fabrics, etc. And also any heating/ massaging functions the recliner may include. In general, insurance companies see this as simply a piece of furniture and/or conveniences that are non-medical and therefore un-reimbursable.
As such, if your claim is accepted — your insurance will generally only compensate you for the value of the motorized lift system. You will need to pay the remaining amount yourself for the remainder of the chair.
Medicare guidelines (gold standard)
Since many Private Insurance companies mimic medicare’s requirements, reviewing medicare’s policies allows us to best determine what types of medical necessity claims are required to be submitted. To receive reimbursement for the motorized portion of a patient lift chair, your healthcare provider needs to ensure you meet very stringent criteria regarding medical necessity.
Essential requirements to meet for reimbursement
There are five essential elements that must be documented by your healthcare provider to qualify for approval:
You must have severe arthritis/hip/knee issues or neuromuscular disease:
your doctor should specify that you have a severe case of either hip/knee arthritis or another severe neuromuscular disorder (muscular dystrophy/parkinson’s disease).
Unable to get up:
you must be completely unable to stand up on your own from a normal armchair in your residence without assistance.
Once upright you must be able to walk independently/cane/walker:
once you have been helped to an upright position by the chair you must be able to walk independently or with a cane/walker. If after using the chair you continue to be unable to ambulate — then the chair has not resolved your mobility issues sufficiently.
This must be part of larger care/treatment program:
the chair must be ordered by a licensed healthcare professional as part of an overall treatment/care program designed to improve your current medical status or slow its decline.
Therapeutic interventions tried first:
before ordering a chair your medical record(s) must reflect that various forms of traditional therapies (physical therapy) have failed to restore your independent ability to rise from a seated position.
Important tip:
do not simply purchase a lift chair based upon medicare coverage alone. Your healthcare provider must write a prescription that clearly states it is necessary for medically-necessary reasons prior to purchasing; additionally, you must buy the chair from a Supplier who has enrolled in medicare.
Private Insurance/Medicaid programs — expect similar experience
Similar to medicare — Private Insurance plans (Blue Cross/Aetna/united healthcare), medicare advantage plans and Medicaid programs have varying degrees of success depending upon where you live.
Many Private Insurance carriers mirror medicare’s approach but may allow for pre-authorization requests prior to making payment for the motorized element of the chair — allowing you to know how much they will pay prior to handing them your credit card number.
Medicaid programs vary greatly depending on state. Many states have more relaxed standards than medicare regarding Home and Community-Based Services (hcbs) waivers — if used correctly — will cover the full cost of a lift chair for an eligible individual — if it keeps him/her living independently in his/her own home and not requiring placement into a nursing home facility.
Temporary Needs vs. Long term solutions
It can take several weeks/months of back and forth paper work with an insurance carrier to obtain approval for medically-necessary equipment. What happens if your mobility limitation is immediate yet temporary (i.e. Recovering from major hip/knee surgery)?
If a long term purchase does not make fiscal or practical sense — renting medical equipment may be the most viable option. While lift chairs are sometimes available for rent for limited periods through local medical supply stores — many families who require complex recovery strategies look towards modifying the entire bedroom environment.
For example, if a patient is totally bed-bound — or requires precise head and foot positioning to safely transfer out of bed — looking into renting an electric medical bed in GTA (toronto) can be an excellent economical choice compared to buying expensive equipment. Rentals give you access to commercial grade beds delivered and installed in your home at exactly the moment you need them — eliminating both the long-term expense and frustration associated with denied insurance claims.
Increasing your chances for getting insurance approval
Using this checklist will help increase your chances for obtaining initial approval through an insurance carrier:
Schedule a separate meeting with your doctor:
don’t mention it at the end of an annual exam visit — schedule a meeting specifically with your doctor to discuss your mobility limitations.
Use exact terms:
make sure your doctor documents terms like “medically necessary,” “severe” — “arthritis /neuromuscular disease,” “unable to transfer independently” in their clinic notes.
Get a certificate of medical necessity (cms form # 849):
for medicare, your DME Supplier needs a completed CMS-849 form signed by your physician.
Purchase from a certified DME Supplier:
only purchase from a Supplier that has experience processing medical insurance claims. Suppliers are aware of how to properly document and bill invoices for separation of the motorized mechanism from The Furniture Component.
Conclusions
While insurance rarely covers 100% of the cost of a lift chair — there is no doubt that it can certainly reduce the costs. By realizing that your carrier will generally only pay for the cost of the motorized mechanism — you can establish reasonable price expectations.
Before shopping around for lift chairs — spend time preparing for and completing paperwork prior to purchasing. Work closely with your primary care physician and explore temporary rental options of medical equipment locally — if you require a quick resolution to address an emergency situation while awaiting approval for your claim. Protecting your joints and maintaining your independence is definitely worth the effort!