Mobility aids are essential to help anyone walk easier. This could be from old age, accidents, surgery, or any other issues that would cause moving to be difficult. But not everyone can afford mobility aids and may need help trying to get one to help move more independently. Knee walkers are even easier to help walk than say crutches so we get A lot of questions emailed to us will insurance cover a knee walker? This question is not as simple as a yes or no answer, unfortunately. We will explain what the process might be to get a knee walker and who may qualify for one.
So will insurance cover a knee walker? This will depend on a few things, however, in general insurance does not cover a knee walker because it is not considered a DME or Durable Medical Equipment. But there are times that someone may qualify for full or partial insurance cover for a knee scooter.
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Will my insurance cover a knee walker?
Although Medicare covers DME (Durable Medical Equipment) and classifies a Knee Walker (also known as a Knee Scooter) as a DME, we understand that many insurance companies will not cover this type of aid.
Depending on your specific policy, Medicaid may cover a knee walker, but you must consult them beforehand.
Why Doesn't My Insurance Cover The Full Cost Of A Knee Walker?
Medical Insurance (Part B of Medicare) benefits may include the costs of buying or renting DME. Still, a knee walker does not meet the requirements of the Medicare Part B coverage program.
You may get additional coverage options to help with the cost of a knee walker from medicare benefits through dual eligibility with Medicaid or a Medicare Advantage plan. However, such benefits depend on the insurers and the state in which they operate.
Supplemental Insurance Coverage
If you have an Accident Insurance (Accident Advantage) policy with supplemental insurance coverage via Aflac, their appliance benefit program may cover the costs of your knee walker.
The amount covered under this program depends on your option levels, but it averages about $200. You may find out the exact coverage amount by referring to your Accident Advantage policy. You may also get in touch with your Aflac agent to get more detailed information.
Which Private Insurers Cover A Knee Walker?
If you own a private insurance policy, some insurers may cover the costs of buying or renting a medical knee walker. But, again, it depends on your policy. You may contact your insurance company to determine if it covers a knee walker’s rental or purchase costs.
Even though your insurer may tell that it does not cover the costs of a medical DME, there are chances that it might cover it after the fact. So it does not hurt to try for it; still, there is no guarantee. You will need solid documentation with a good dose of persistence. Here is how:
You must file the insurance claim by following some specific insurance coverage guidelines. In addition, there are ways to insist upon the insurance company to cover your expenses after your treatment is complete. We have prepared a checklist and already provided you with most of the documentation you may need. First, however, you must contact your insurer to check if it can cover a knee scooter.
You may need the following two codes before making a call. You may contact the number on the back of your insurance card.
- The Knee Walker Code HCPCE0118 (A Crutch Alternative)
- The Diagnosis Code (You must obtain it from your doctor)
What is a Diagnosis code or a procedure code (CPT)?
A diagnosis code, aka procedure code, refers to the surgery or injury that your doctor identified to treat you. You may get the code from your doctor’s office.
For instance, your insurer may not cover a knee scooter for CPT Code 30450 Nose surgery (Rhinoplasty), NWB (Non-Weight Bearing), but it may cover a knee scooter for Rupture, Achilles Tendon, CPT Code 727.6.
Please note that the code used by you should match with the code provided by your doctor, or else your claim may get delayed.
When Should You Call Your Insurer?
You should ensure to document the call details while getting the answers to the following three important questions, including the date and time of your discussion and the person’s name on the call.
- Is the expense of crutch alternative – with or without wheels (HCPCsCode E0118) covered under the policy?
- What is the level of coverage? (Dollar amount of %age covered by insurer)
- Are there any additional requirements? i.e., Rent Vs. Purchase; A network provider etc.
While Submitting Your Claim?
When you submit the claim, make sure to include the following documents, irrespective of the answers of your insurer:
- A letter from your doctor indicating the medical need for a knee scooter.
- A signed prescription of doctor
- A paid receipt
Do You Have A Right To Appeal?
You have all rights to appeal against the decision of your insurer. Usually, people get the in-network requirement waived because they cannot find a knee walker locally. Even if the insurer considers your knee scooter a non-coverable expense, it may still count as an insurance deductible. Moreover, you may check with your tax return preparer because your knee scooter can be deemed a medical expense on your tax return.
How much are knee scooters? You might be surprised
Knee scooters can run anywhere from $250.00 to over 600 dollars or more. depending on the model and features. When looking at the overall price of a knee walker they are not incredibly expensive as say an outdoor power scooter but not as cheap as crutches.
Take a look at our review of some of the best knee walkers and scooters to learn more about what you can expect on pricing and features.