Will insurance cover a new wheelchair if my child outgrows theirs?

Insurance companies expect that children will outgrow durable medical equipment like a wheelchair over the years, but you may experience trouble if your child outgrows their chair more quickly than expected. For example, insurance may agree to replace the wheelchair every five years, but if your child outgrows it in three years, insurance might try to deny your claim for a replacement on that basis.

Undivided's Director of Health Plan Advocacy, Leslie Lobel, recommends calling your representative at your DME provider and asking if they have experience with working around the insurance challenges, whether that's your private insurance or Medi-Cal. For example, you could ask what they do with other clients who have had growth spurts in less than five years. Your health plan will also have an appeal process for disputing denied claims.

Undivided's Public Benefits Specialist, Lisa Concoff Kronbeck, is available for consultation if you need additional help troubleshooting this issue with Medi-Cal.