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Medicare issues delay man's need for upgraded wheelchair
By Paul Swiech
pswiech@pantagraph.com
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BLOOMINGTON — Kevin Schaefer owns and runs a Bloomington-based computer business, is married, has a son and is active in his church. | Photo Gallery

But the soft-spoken, 42-year-old Downs man is in the middle of a dispute with Medicare, and his church family is rallying around him.

Schaefer is paralyzed from the upper chest down. He uses the same power wheelchair that he purchased shortly after the 1991 swimming pool accident that resulted in his spinal cord injury.

A doctor has recommended that Schaefer, for medical reasons, get a power wheelchair with a “standing function” that would help him to be upright from time to time.

But representatives of Medicare and wheelchair manufacturers won’t tell Schaefer how much Medicare will pay for a wheelchair with a standing function — which could cost $26,000 to $30,000 — until after he buys it. All Schaefer knows is that Health Alliance, the private insurer to whom he pays premiums, will cover 20 percent of what Medicare won’t pay.

He has appealed to his congressman, U.S. Rep. Tim Johnson, an Urbana Republican.

“I don’t understand why he hasn’t gotten answers,” said Beth Harding, an aide in Johnson’s Bloomington district office. “I’m anxious to find out.”

“I don’t expect Medicare to change their rules for me,” Schaefer said. “But I think it’s reasonable to ask why I can’t get someone from Medicare to tell me how much I can get reimbursed.”

As Schaefer waits for answers and continues to use an outdated wheelchair, members of his church, St. Luke Union Church in Bloomington, are sponsoring a fundraiser Saturday to help cover the balance after Medicare, Health Alliance and the Schaefers put in their shares.

“Kevin could be sitting at home, drawing full disability,” said Laurie Vial, a friend of the Schaefers and the fundraiser chairwoman. “Instead, he’s running a business that employs several people. To see him using his brain and using a computer by punching a keyboard with pencils attached to his (wrist) braces or manipulating the computer using voice recognition software is inspirational.

“He’s got a great attitude, is upbeat, funny and articulate,” Vial continued. “We’re frustrated by the red tape of Medicare and the insurance company and we’re trying to jump in with a grass-roots effort.”

Schaefer owns Ctech, which does Web development and computer networking services for small businesses, at 3901 GE Road, Suite 3B, Bloomington. The business has seven employees, including Schaefer and his wife, Becca.

He and his wife have a son, Carson, 6.

Schaefer has minimal movement of his shoulders, upper arms and forearms, but no movement of his wrists and fingers. He uses a joystick to operate the wheelchair. He eats by attaching a fork or spoon to his wrist braces and drinks using long straws.

Last spring, Schaefer developed a pressure sore on his backside after a bruise didn’t heal following a fall, Dr. Marcia Hauter said. Hauter is the medical director of the BroMenn Center for Wound Healing & Hyperbaric Medicine in Normal, where Schaefer went when the sore didn’t heal.

Hauter worked with Schaefer on increasing his upper body strength, his technique transferring in and out of his wheelchair, and wound care. After about 2½ months, the wound healed.

But Hauter, knowing that pressure sores are common among people in wheelchairs, is concerned that another wound may develop. A pressure sore could lead to fatal complications.

Hauter recommended a wheelchair with a standing function, which would take pressure off Schaefer’s backside, reduce the risk of more pressure sores, exercise his bones and assist in digestion, she said.

Even though Schaefer pays for a Health Alliance policy, Medicare requires that it be the primary insurer for people with a permanent disability who work for a company with fewer than 100 employees. In addition, Medicare may not pay for the standing function, but Schaefer can’t confirm that.

“None of this makes any sense to me,” he said. Becca Schaefer said she’s frustrated because she and her husband have had a lot of out-of-pocket expenses related to his disability and don’t ask for much.

But Kevin Schaefer appreciates the effort going into the fundraiser.

“It makes me feel valued.”

New Wheels for Kevin

What: A fundraiser to help pay for a new power wheelchair for Kevin Schaefer.

When: 3 to 8 p.m. Saturday

Where: St. Luke Union Church, 2101 E. Washington St., Bloomington

Activities: Dinner, silent auction, raffles, bake sale, crafts, music, drama. Donations will be accepted.

For more information: Call (309) 663-7437 or go to www.stlukeunion.org. Donations also may be made to the church, with “New Wheels for Kevin” in the check’s memo line.

SOURCES: St. Luke Union Church, Laurie Vial

Take a look
Kevin Schaefer, left, and his wife Becca, center, help customer Jamie Wilson, right, Wednesday (Oct. 17, 2007) at their business in Normal. (Pantagraph/CARLOS T. MIRANDA)
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Reader comments on this story - 53 total

Note: All views and opinions expressed in reader comments are solely those of the individual submitting the comment, and not those of the Pantagraph or its staff.

Twila and George wrote on Oct 22, 2007 9:07 PM:

" Kevin and Becca, We know your frustration, we'll see you Saturday. We know this benefit will be a big success! "

Yo Fred wrote on Oct 22, 2007 8:03 PM:

" Right on! Hope these folks get help......No one knows how fast they could just be in the same predicament.... "

Try Durbin wrote on Oct 22, 2007 4:46 PM:

" Perhaps a call to Senator Dick Durbin. He is on the senate subcommittee on Health and Human Services which has jurisdiction over the Centers for Medicare and Medicaid Services. "

Unbelievable! wrote on Oct 22, 2007 3:19 PM:

" Only in B-N would an article emphasizing a fundraiser to help someone in need turn into a political issue. Read the article, people, attend the fundraiser and DO something to help a neighbor instead of using this article message board as a place to vent your political viewpoints. "

to Hillary supporters wrote on Oct 22, 2007 2:45 PM:

" Sure do, but only after Johnson is replaced by someone who gives a **** about his constituents. "

Hillary supporters wrote on Oct 22, 2007 1:22 PM:

" read this article and see if you still want ALL healthcare run by government. "

Just Heard wrote on Oct 22, 2007 1:11 PM:

" That the McLean County India Associaiton(MCIA) are conducting a raffle during their annual banquet to benefit Kevin. Hurrah! "

MRS. wrote on Oct 22, 2007 12:57 PM:

" When my husband got his motorized w/c the company that sold the chair, my husband and the Dr had phone conferences with Medicare. If approved the company waited until Medicare paid what they cover (usually 80%) and we paid 1100.00 That is why those commercials say if they give you the chair and Medicare refuses the claim you get to keep the chair. They don't give you the chair until Medicare has paid them I understand this is a much more expensive chair but it seems to me it should work the same way. Of course Medicare will not buy a 100.00 nebulizer but they will rent one for you paying about 55.00 a month for up to 15 months. Lets see that is 825.00 they are paying on a 100.00 machine. Medicare has to work overtime trying to make things a difficult as they can. Of course they are Government and any time you get government involved you are sc*!#^* "

Costanza wrote on Oct 22, 2007 12:42 PM:

" Laurie Vial states in the article that they are "frustrated with the red tape of Medicare and insurance." What has Health Alliance done wrong? It appears that they've been up front about the fact that they'll pay for 20% of the cost that Medicare doesn't cover. What have they done wrong? Please don't indict "insurance" and don't lump them in with the Medicare program. "

TO: to confused wrote on Oct 22, 2007 12:39 PM:

" it seems that you are the confused one - Medicare and Medicaid are two different programs. Medicaid IS based on wealth and income. It is basically for those who are poor or indigent and cannot pay for their own medical care. Medicare is what all seniors are a part of (and the disabled like Kevin). Big difference. "

to Touched wrote on Oct 22, 2007 12:38 PM:

" don't lump "insurance" in with Medicare. According to the story, Health Alliance already was up-front with him and told him that they would cover 20% of the balance that Medicare doesn't cover. They've given him the information he needs... its Medicare that is not being up-front with the information. "

JTE wrote on Oct 22, 2007 12:25 PM:

" The point of conflict here as Kevin reiterates in his post is not that Medicare ore Health Alliance won't pay. It's that Medicare does not have a process to let him know how much he's got to pay out of pocket. Kevin can't tell if the wheelchair is going to cost him $30,000 or $3,000, or $300. And he's got to commit to the whole cost, buy the chair, file the claims, and wait to see how much it is. Now, that's a terrible way to plan one's finances! "

Wondering wrote on Oct 22, 2007 12:14 PM:

" Sounds like a very worthwhile cause. Does anyone know what kind of music will be there (country, rock...etc.)? "

ph0neman wrote on Oct 22, 2007 12:05 PM:

" Kevin and Becca, this is a bit ridiculous that you two have had to put up with this and have had to make a public appeal to get this taken care of... many of us look up to you and applaud your progress and your work ethic. Good luck with the Medicare thing... I have a feeling after your benefit you wont need to worry about it. Take care. "

To:fred smythe wrote on Oct 22, 2007 11:29 AM:

" Look things over taxes aren't the problem. Without taxes we wouldn't have public schools, police, fire departments, maintained roads, water and sewer departments, libraries, museums, courts, jails, and many of socities other needs wouldn't be met. I know people will complain those things cost too much or are in poor shape. To those people go to Sweden where the tax rate is closer to 50% (they have nationalized healthcare and free education through college) or go to a third would country without running water, only private education (that no one can afford), and crime rates that make New Orleans look peaceful. People around here don't realize nothing is perfect, but we are very lucky to have what we have. And most people are missing the point of the article, the man just wants to know how much is going to be covered before he purchases the his doctor has advised him to get. Don't we all like to know how much something will cost before we buy it? "

to fred smythe wrote on Oct 22, 2007 11:26 AM:

" Correction, if working families didn't have to pay so much for health insurance, they might be able to buy what they need. My health insurance burden has ALWAYS been higher than my tax burden although Unit 5 and Heartland are trrying to change that! "

What a great Man! wrote on Oct 22, 2007 11:25 AM:

" My father was in a very similiar situation and recently passed, I will pray for Kevin in hopes he gets his wheelchair. Too bad the state doesn't realize how much this man really has achieved and help in achieving more. Like the store said in the passed 16 years can they imagine how much money they would have been putting out for full disability. They owe him this wheelchair. Good Luck! "

Correct me if I'm Wrong wrote on Oct 22, 2007 11:08 AM:

" If I am reading the article correctly, all he wants right now is to know if medicare will cover it and how much they will cover. He is not waiting for reimbursement. That should be an easy question for medicare to answer and should not take months to find out. It is not unreasonable to expect to be able to get a quick answer. We are talking about the government, though. "

Kevin wrote on Oct 22, 2007 10:53 AM:

" Two very important points: 1) Medicare eligibility is not based on income but based on age or having a permanent disability. I was accepted in a group health insurance plan (Health Alliance, ECHI group since 1995) with a pre-existing condition yet the health insurance company gets to push my expenses off on the Medicare system because of rules that make Medicare the first payer. 2) Medicare approves less-expensive powerchairs (they designate Class 3). I am willing to pay for extra features (standing capability) out-of-pocket but Medicare will not tell the vendor of the powerchair how much they will be reimbursed. So I cannot find out what my out-of-pocket expense is in order to decide if it is affordable. I am being told both by the vendor and my excruciating long calls to Medicare that they have no procedure to predetermine the benefit amount and that the reimbursement amount could be much lower than if I went with a chair within their guidelines. Finally, I have to take personal responsibility for the full amount ($30,000) with the vendor for them to place the order and then wait and see what happens with Medicare. "

Touched wrote on Oct 22, 2007 10:19 AM:

" I am touched by this story and reading the posts about it. Kevin's customers raving about what a nice guy he is. Medicare and insurance should be able to give straight answers so people know where they stand. A grandmother of a 7-year-old who needs a wheelchair was just on Good Morning America saying the same thing. A better wheelchair will prevent serious problems down the road. Let's help those who helps themselves. I don't know Kevin but I plan to bring my family to the benefit Saturday and take part. This is a heart warming story if there ever was one. "

fred smythe wrote on Oct 22, 2007 10:07 AM:

" You can darn well bet ya tho.....special.....would be used if it were for the congressmen........or the priviledged.............OH yes i forgot they do not need help as they can afford it.............well if people were not taxed so darn much maybe working families could afford what they need to............................. "

to Re: To: "2009" wrote on Oct 22, 2007 9:37 AM:

" Ohhh.... these are fun! I love conflicting talking points!! According to Republicans, Canada and all of the other countries with national health care have a crushing tax burden and their middle classes can barely afford bread. But also according to Republicans, these same taxed-to-death Canadians are coming to the United States and paying out of pocket for medical care, which anyone who has seen an EOB can tell you is very very expensive. So which is it? Are Canadians with national health care taxed to death or are they all rich people who can afford to pay full price for American medical care? "

to TO: Hilary Clinton wrote on Oct 22, 2007 9:33 AM:

" Hillary Clinton wanted government to run Health INSURANCE, not medical care. I don't go see BlueCross when I'm sick, I see my doctor. "

To "Attorney" wrote on Oct 22, 2007 9:32 AM:

" So what you are saying in a nut shell is that congressmen are worthless when it come to help. I did not say I expected anything to be changed. My social security was screwed up and not by anyone but social security inabilities to correct it. I asked for help in getting it straightened out, not for anyone to change any rules to accomodate me!! So far they have not answered anything that I have asked for. So some people aren't asking for anything but something as simple as getting things corrected!! "

Carl wrote on Oct 22, 2007 9:09 AM:

" Wake up people. Government health care - you must be joking! I understand some of us don't have health care insurance, and a better system is needed, but Government health care would equal either no or inadequate health care. Look what happened in Canada! Everyone crying for Government health care now, would be just as vocal later complaining about not being able to go to the doctor of their choice, or having to go to a doctor that they don't like, or not being able to be seen by a doctor for months on end. We don't need reform in the current health care system, what we need is reform in paying for that health care. Either affordable insurance or a voucher system to use as the patient sees fit. Remember, it's our sue crazy society and over large settlements that gave us these high rates to begin with. "

Figures wrote on Oct 22, 2007 9:02 AM:

" They would rather hand over all the money and link cards to people that don't even try to work but spend time smoking and drinking their life away. They don't have to pay for medical bills or anything. Someone that deserves help with a wheelchair has to fight for it. Somethings wrong here. "

TO: Hilary Clinton wrote on Oct 22, 2007 8:47 AM:

" Not true.... She WANTED the gov to run all our medical care, but the pharmaceutical companies bought her out like they did everyone else... I for one would LOVE for the gov. to run all our medical care. Then maybe I could have the dental work I’ve needed for 6 years, or my grandfather could get his prescriptions each month without us all going bankrupt! Im sick of insurance not covering medical issues because of lame excuses. They are rolling in it and we are suffering. My mother lives in Canada and she can have any med, any procedure, go in to any ER, any walk in clinic, any dr. appt for ANYTHING at ANYTIME and get treatment an walk out without paying a bill. She loves it... Im so sick of America whining that the taxes would raise, SO WHAT? We would be paying LESS in taxes than we do in premiums and paying off all the medical bills that were not covered by insurance. WAKE UP AMERICA! "

Iraq War wrote on Oct 22, 2007 8:40 AM:

" You Republicans want your Iraq war and an Iran war and then complain when there's no money for Domestic issues. You can't have it all. "

Umm... wrote on Oct 22, 2007 8:30 AM:

" He just wants them to tell him how much it will cost. Is that really breaking their rules? "

Re: To: "2009" wrote on Oct 22, 2007 8:10 AM:

" Move to Canada then and see why they all come to the US for treatment. "

To: I hope this benefit wrote on Oct 22, 2007 7:29 AM:

" Glad you're not partisan about this. "

The emotional answer that we all want... wrote on Oct 22, 2007 6:28 AM:

" ...for Mr. Schaefer may not be the one that he should get. I see someone who is supporting himself and staying off welfare after an accident that many might use to justify being forever supported by others. He is productive, cheerful, and deserving, so why not? But, an agency makes precedent when it gives a $30,000 wheelchair to someone. So, why doesn't everyone get stand-up wheelchairs or electric sit-up beds? If not for everyone, someone is sure to say that Mr. Schaefer got his only because he was a business owner with pull and not a "little guy". Healthcare is a form of insurance; those that are disabled are subsidized by those that are well and productive. That's manageable as long as the ratio between the two groups, and the costs incurred, stay reasonable. But, if standards for qualification are lowered or benefits are liberalized, the burden will fall on those that do work and pay for it. And, then we’ll ask why Medicare premiums are so high. I like the idea that we can help people to help themselves and hope that the rules can provide for that attribute without having to give everyone the same thing. "

!?!?! wrote on Oct 22, 2007 6:19 AM:

" Maybe the thing we could all do to help is pick up our phones and call Brady, Brady, Johnson, Durbin, etc till they get up off their butts and do their jobs. Maybe we should all remember the problems that people have when election times come around and vote for someone else. "

Attorney wrote on Oct 22, 2007 5:23 AM:

" Even congressmen and senators are limited in what they can do. Remember that they are only one vote out of over 500, and have no direct authority over a federal agency, which does have its own rules and procedures. In fact, an elected official must be careful to not urge an agency to break its own rules, lest there be accustations of asking for special treatment. Finally, many people will say that their congressman is useless just because they didn't get the outcome they wanted. Much of the time, people go to their congressman because they want an exception made for them, and when they don't get it, they are upset that the rules didn't get changed or some enforcement didn't get dropped. About all a congressman can really be expected to do is to get some attention to a matter that is being ignored, but not necessarily get a desired outcome that contitutes special treatment. So, Mr. Schaefer can hope that Rep. Johnson can get his question looked at sooner (or possibly see the need to introduce corrective legislation), but can't expect the congressman to get him special treatment. "

All those for wrote on Oct 22, 2007 2:18 AM:

" the democrats socialized medicine should think twice. Government can't perform as well as private industry. All have faults, but wouldn't you want the choice with fewer faults? ie, privatized healthcare "

To: "2009" wrote on Oct 22, 2007 1:39 AM:

" I don't think it's just government healthcare-it's NO healthcare for people like me. I can't get on Medicaid, I can't afford to buy health insurance, I can't GET health insurance even if I could afford it because of my 'pre-existing condition.' I am in an income level that is 'just a wee bit too high' ($200 a year too high) to get help from the government and I'm just too damnd poor to buy a policy, which would have conditions in it regarding my 'pre-existing' condition or would have deductibles that I can't pay. So, you know what I do? I just wait to die. Government healthcare would be a 'dream' to me. Sorry, but it would be. "

I hope this benefit~~ wrote on Oct 22, 2007 12:47 AM:

" will help Kevin, but if he is waiting for our congressmen to help him all I can say is good luck. It appears that once they get in office they forget the little guy and can't wait for the next raise in pay!! I turned to Jerry Wellers office for help and that was back in April, I'm still waiting to hear from them! I don't imagine I will either. I went through all the hoops they asked for and nothing. They are an insult to our country along with all the rest of our government. I'm sick of all the money going to either pockets or some country I've never even heard of. We should be getting help here where WE pay taxes and PAY OUR GOVERNMENT TO REPRESENT US NOT SOME FOREIGN COUNTRY!!!! We are paying for a war GWB started and now doesn't know what to do with it! We need the help here for people like Kevin that need it, so if any form of government official is reading this, DO YOU GET THE MESSAGE!!! "

Hillary Clinton wrote on Oct 21, 2007 11:36 PM:

" Wants the government to run all of our medical care. Any Questions? "

I do not care wrote on Oct 21, 2007 10:47 PM:

" That this man has a good reputation. I do care that he has the medical need for a new chair. Why should a disabled person have to beg for a replacement on something that has been used far past its time? Oh, I forgot - we need to save money for more important things like war-mongering. Most Americans would never keep the same car for 15 years, even if they seldom used it. Pathetic. "

2009 wrote on Oct 21, 2007 10:16 PM:

" welcome to government healthcare "

seen it happen wrote on Oct 21, 2007 9:43 PM:

" I work for a agency that works with individuals with disabilites. I have seen people who are waiting for over 2 years for Medicare to assist them with get a new wheelchair. Many times they are told that they will get the chair in a couple of months. I know a woman who has been waiting for over 3 years. Good Luck to Kevin in getting a wheelchair. "

Jon wrote on Oct 21, 2007 9:30 PM:

" Kevin is a GREAT guy and I sure hope this benefit goes well. We will see you there! "

From: I'm confused: wrote on Oct 21, 2007 9:20 PM:

" Thanks for the clarification. "

reader wrote on Oct 21, 2007 9:15 PM:

" We seem to have plenty of money to give cancer treatment to illegals or send money to countries that don't like us,but, we don't have money to help US citizens. "

To: I'm confused wrote on Oct 21, 2007 9:04 PM:

" Medicare and Social Security come in many different forms, even people who are only partially disabled can pull some kind of insurance...sometimes you are forced to sign up years ahead of when you'll actually need it, even if you currently have insurace....depending on your insurance company they may have Medicare be primary or secondary "

Customer of CTech wrote on Oct 21, 2007 9:03 PM:

" Kevin and Becca are genuinely good people. (Do a great job with broken PC's, too.) "

to confused: wrote on Oct 21, 2007 8:34 PM:

" Medicare and Medicaid have nothing to do with wealth, prosperity, or success. They are social programs that cover the needs of all retired and disabled citizens in the USA. It's a testament to Kevin's vigor that he succeeds at living a life as he does, but the business is probably owned by both he and his wife. The point of disability medical coverage like Medicare is to provide medical care so that people can live full lives and work on their own like Kevin. The difference is that Kevin is probably not drawing disability benefits that would pay for things like food and housing. As stated in the article, Medicare requires that it be the primary insurer for disabled people working for companies with less than 100 people. Kevin's business has 7 employees. No matter how much money the business makes, Medicare rules insist on being his medical care provider - even though he pays for a private policy. "

to:I'm confused wrote on Oct 21, 2007 8:26 PM:

" think about it. he could be setting home letting you pay your taxes so he could watch TV. kevin and becca are great people to do business with and they only ask for some help when some thing comes along that cost a ton of money, like this wheel chair. kevin like to work and loves people, you could help and keep his needs from the government to a small part. "

sad wrote on Oct 21, 2007 8:08 PM:

" I feel for this family and I hope he gets enough raised to get the wheelchair. "

I'm confused wrote on Oct 21, 2007 7:44 PM:

" and don't mean to be disrespectful, but how can he own his own business, have insurance and still get medicare benefits? "

I know Kevin wrote on Oct 21, 2007 7:31 PM:

" And he is one of the nicest guys you'd ever meet. If anyone ever deserved a new wheelchair, it's him. "

Friend wrote on Oct 21, 2007 7:28 PM:

" Looking forward to performing at the benefit this Saturday, I'm sure it'll be a blast! "

heartbreaking*** wrote on Oct 21, 2007 7:26 PM:

" Now, if he was an illegal alien, I wonder how fast he would have gotten yet. Yesturday, I'd guess. "
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