For people with disabilities, purchasing and maintaining a wheelchair is a necessity. However, high costs and insufficient insurance coverage can prevent wheelchair users from affording the devices they need to live their everyday lives. In a federal class action lawsuit, several wheelchair users are accusing a major insurance company of discriminating against disabled people.

In an interview for “LA Times Today,” staff writer Emily Alpert-Reyes joined host Lisa McRee with more.

What You Need To Know

  • Wheelchair users and the California Foundation for Independent Living Centers filed a class action lawsuit against Kaiser Foundation Health Plan and the California Department of Managed Health Care over high costs

  • Motorized wheelchairs can cost as much as $50,000 and insurance rarely covers that cost

  • Health plans in California usually don’t cover chairs that are used outside the home

  • Government plans like Medi-Cal offer better plans for wheelchair users, without an annual dollar cap on medical devices

Wheelchairs can be expensive, and the cost of a chair varies widely.

“Manual wheelchairs, the kind you push with your arms, ones that would be suitable for everyday use, could range from $3,000 to $5,000. But a motorized wheelchair or a power wheelchair could cost tens of thousands of dollars, potentially as much as $50,000,” Alpert-Reyes said.

The rules about what types of wheelchairs insurance companies cover are all over the map.  

“Some of the restrictions that these disability rights groups are concerned about are annual dollar caps, a limit of how much you spend annually. Two thousand dollars is not going to cover much if you need a $50,000 wheelchair or even a $17,000 wheelchair,” Alpert-Reyes explained. “There is also the Home Use Rule. This is the idea that if you can get around your own home but if you want a wheelchair to get to your work or the grocery store, or anything else you might want to do in your daily life, insurance may not cover them.”

For some, it is better to be unemployed since government programs cover more than private insurance can.

“This was something that Christina Mills, with the California Foundation for Independent Living Centers, mentioned as something that really bothered her. She’s someone who has a career. She gets private insurance from her employer,” Alpert-Reyes said. For Mills, if she was on Medi-Cal, she would have better options for getting her chair covered.

“Medi-Cal has no annual dollar cap on durable medical equipment or wheelchairs that are considered medically necessary, and it will cover equipment used outside the home as well. That’s different than some private plans that people complain about,” Alpert-Reyes said.

Some wheelchair users are so desperate to get new equipment or repair their equipment that they start GoFundMe pages. People even try to repair their chairs on their own with duct tape and tools.

“One of the people I talked to was Beth Smith. She’s 62 years old, she has cerebral palsy, and she’s just dreading when her wheelchair finally gives out. She’s been using it for years. She described that she and her partner will go to the hardware store and get screws and try to make it work however they can. They don’t want to be on the day when she can’t use it, and they have to figure out how to scrape together $17,000 for a replacement chair.”

Russell Rawlings’s wheelchair keeps dying, sometimes out in the middle of a trip to the market. Alpert-Reyes said every time the chair gives out, he worries it won’t start up again and he’ll have to pay for repairs.

Wheelchair users and advocacy groups have filed a class action lawsuit to get better coverage for medical devices.

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“Russell and Beth… are among the plaintiffs in the suit, as well as the California Foundation for Independent Living Centers. They are suing Kaiser Foundation Health Plan, which is one of the biggest commercial health insurers in the state and the California Department of Managed Health Care, which regulates health insurance plans of the state. They are arguing that both the state agency and Kaiser have discriminated against disabled people by failing to cover wheelchairs of potential health benefits,” Alpert-Reyes said.

“Under Obamacare, those particular things that are supposed to be essential health benefits that are covered by all commercial plans and the state regulates that by setting a particular plan as the benchmark plan. According to the lawsuit, the state chose a Kaiser plan that does not cover wheelchairs. What they are saying is this is bigger even than just people who have Kaiser insurance because the state has used their plan as a benchmark. This means that other insurers can also have very limited or no coverage of wheelchairs,” she explained.

There have been efforts in the state Legislature to get better coverage for wheelchairs before.

“There were some bills back from 2008 to 2010, or so. One passed the Legislature, but they were vetoed by Gov. Schwarzenegger at the time, who raised concerns about increases in premiums. Advocates pointed out that the California Health Benefits Review program found that… those increases would be largely offset by the reductions in out-of-pocket spending that would happen. Nonetheless, that legislation never succeeded. There really hasn’t been much of an effort in the Legislature for it for a long time, which I think may be why groups decided to go the route of a federal lawsuit,” said Alpert-Reyes.

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