Understanding the Benefits and Risks of Purchasing Mobility Equipment Online
- By Elisha Bury
- Feb 01, 2013
You're no stranger to online shopping. With a click of the mouse you can pull up hundreds of digital cameras, stylish clothing and accessories, and even power and manual wheelchairs—all at competitively low prices. So what's to stop you from hitting "purchase" and having your next mobility product delivered right to your front door?
Not much, according to Simon Margolis, executive director of the National Registry of Rehabilitation Technology Suppliers (NRRTS), an association for providers of complex mobility equipment. "I think that the consumer has the sense and the sensibility to look at things and decide what's best for them," Margolis says.
"And if they do their research and they're careful about that, they may be able to find what they want on the Internet."
However, when it comes to high-end wheelchairs and pressure management and positioning products, purchasing online might not only be a disadvantage, it might be dangerous, says Elaine M. Stewart, ATP, CRTS, branch manager of National Seating & Mobility, Inc., in Fort Wayne, Ind.
So how do you know when to buy online and when to head down to your local mobility provider?
When you decide to look online for mobility equipment, your reasons could be many. Stewart says a lot of times the timeframe is too long when it comes to going through the insurance process. It could take two weeks to secure qualifying documentation. Also, she says if the equipment won't be covered by insurance, a lot of consumers will decide not to purchase through a mobility provider.
Another reason consumers might be driven to the Internet is because of poor relations with mobility equipment providers, Margolis says. And he admits that there are some bad apples out there.
Providers who take a cookie-cutter approach to selling equipment, meaning everyone with a certain diagnosis gets the same equipment, or providers tied to closely to manufacturers who sell equipment based on volume discounts can leave consumers with a bad taste, Margolis says.
In addition, consumers can become frustrated with providers who aren't set up to work with insurance companies and Medicare/Medicaid, he says.
"Some consumers have the feeling that all the supplier is there to do is make money. And the bottom line is, yes, the supplier is out to make money—it's a business," Margolis says. "But the good supplier understands that the way you make money is by doing good things, by taking care of your customer."
Fortunately, most mobility providers do take care of their customers and can provide valuable information to assist consumers in the purchasing process. When you work with a good mobility provider, your money pays for an all-important knowledge base that can ensure you get the most bang for your buck.
Margolis says that suppliers know
- How to match equipment to specific needs, including physiological, functional and quality of life needs
- How wide equipment is and whether it will work in a client’s home
- The service history of certain brands and models, including how often repairs are needed and replacement parts are available
- The history of a manufacturer—how long a manufacturer has been around and is likely to stay around
"I generally find that most of our customers … appreciate us being able to provide demo equipment so they can actually get their hands on the equipment and visually see (and) kind of kick the tires if you will," Stewart says. In addition, she says providers can give customers details on whether a custom configuration is available for a product, either through the manufacturer or through the mobility provider as well as whether a product is covered by insurance.
That being said, there are a few products that don't necessarily require a mobility provider, including many bath products, walkers and canes, Stewart says. Those are the items that might be worth purchasing online.
Let's say you aren't newly injured, newly diagnosed and you don't think you've had any significant changes in condition. Margolis believes you could possibly find a product to suit your needs on the Internet. However, by not working with a mobility provider, you might be missing out on an important advantage: the team advantage.
"The difficulty is that no matter what the diagnosis of an individual, needs change over time. Even if they have a 'nonprogressive' disability or disease process, things change with age; things change with other circumstances in an individual's life," Margolis explains. "The way someone was sitting before may not be the only or best way for them to sit now. And if they're not going to be working with a mobility provider and a clinician, they're not going to have access to those alternative positions or to the alternative adjustments of the chair. It's virtually impossible, for example, to duplicate a chair."
Stewart says that the mobility provider and clinician work hand in hand to ensure that both skeletal and postural adjustments are made through the fittings and trial period.
"Sometimes if a cushion is slightly off, we're able to modify that in order to best fit the client. Whether or not there's hardware involved for say lateral stability, we're able to provide adjustments in that way," Stewart says. "We're also able to assist to make sure the equipment will fit into the environment of its use, whether it be at home, school, work, their accessibility in and out of their vehicles. Sometimes if families are doing that on their own, those are items that they may not think about."
While Margolis believes that repeat buyers can certainly make educated decisions about wheelchairs and power bases, he's much more concerned about consumers buying pressure-relieving cushions online, even though those products are less expensive.
"There are some very specific physiological needs involved in that in terms of pressure relief and reducing shear force," he says. "I think that in those situations there is a lot more potential danger for a person buying something off of the Internet without having someone at least in the initial stages help them with the evaluation."
Another area of caution is equipment purchases for children. Sometimes parents can locate a stroller for less money, and it meets the needs of their children, Margolis says.
"Other times it is just not appropriate for their child's needs because they can evaluate the needs from one standpoint: the standpoint of what they see," he says. "But there are many developmental issues that you need to look at in terms of growth, in terms of changes over time."
The Cost of Compromise
There's no doubt that sometimes buying mobility equipment online can be less expensive than going through a mobility provider. But consider the hidden costs of the product.
Margolis says to ask yourself these questions:
- How are you going to get replacement parts?
- Who is going to provide the service?
- What happens if it doesn't work the way you expected it to work?
- Is the company going to stand behind the product?
- If the product is wrong, doesn't fit properly or doesn't work correctly, what recourse do you have?
"If they want to view the equipment that they need as a commodity item, then certainly … find the best price. I do that for products I purchase all the time, but I do take a chance," Margolis says. "If I buy a piece of electronics off the Web, I know that I'm not going to have a brick-and-mortar place to bring that to get it fixed. I'm on my own."
That's exactly the situation consumers could find themselves in when buying online, and it has everything to do with the way a supplier is paid for service claims. Margolis explains that unlike car manufacturers that pay for warranty repairs and service, mobility equipment manufacturers offer no such payment, even if they offer a warranty.
"If you buy something off the Internet and you come to a brick-and-mortar supplier and say I need this repaired under warranty, they're not going to do it because they can't afford to do it—because the margin or the profit is built in the sale of the chair and the service is just part of that transaction process," Margolis says. "So you really don't have a lot of potential help if you purchase something from the Internet and it doesn't work the way you want it. Certainly somebody might be willing to repair it, but I do believe that they would want to get paid for that service."
This is especially important to consider when purchasing used equipment from a site such as craigslist or eBay.
"There's definitely not a guarantee of quality. Just like anybody buying anything off of a used list serv, it may look good in the picture, but when you finally get it, it may not be the case," Stewart explains.
If you are trying to build a chair from different parts, Stewart says to be careful because "the parts may not interface well or may not even be usable."
Stewart warns customers to watch out for the little costs that can add up. "If in fact they can't either return or replace (a part), it may become even more expensive—not to mention there could be some medical repercussions for that as well," she says.
Certainly that's true of equipment for sale that might have been customized for an individual. Margolis says that even though the equipment might sell for a significant discount, the cost of making repairs and re-customizing a chair could add up.
While we're on the subject of money, buying online could be potentially problematic for people paying via insurance or Medicare/Medicaid, which most people use when buying high-end complex wheelchairs. If the product doesn't work, then insurance isn't going to provide another one, Margolis warns.
"That consumer is not going to be able to get another product from the insurance company unless the people who collected the money the first time, the Internet seller, refunds the money to the insurance company," he says. "That's not likely to happen."
Even though there's an ample selection of mobility equipment online, there's no Amazon.com for wheelchairs, Margolis says. So what you see isn't always the full range of what's available.
"If you go to various sites, they can only represent certain manufacturers because there are many manufacturers, especially of high-end equipment, that won't put their product on the Internet for sale because there is a need for more fitting and understanding of the specific specifications of the product," he says.
And you really must figure out exactly what you need in order to make an informed purchase.
"The consumer really needs to mirror the research in some ways that the supplier already has done in terms of understanding the equipment and what it can do," Margolis says.
When he sits down with a consumer, Margolis has a checklist of questions to ensure the equipment meets the consumer's needs. For example, Margolis will want to know
- What will the chair be used for?
- What will the equipment need to do for the consumer in various situations? In a given day or week, will you need to go to work, school, church and/or the grocery store?
- What are the potential barriers that you will encounter each day, and how will the equipment meet those needs?
- How will the equipment be transported—by van? Will it fold up?
When you're looking at transporting equipment, Margolis says, you really have to understand what that means. For example, a scooter might disassemble easily on a showroom floor, but how heavy is the heaviest piece? Can you lift it?
"Think about doing that in 20-degree weather in a snowstorm," Margolis says. "That's not going to work quite as easily."
Stewart says she agrees that customers should educate themselves on the types of products available. "I think that's a smart thing to do," she says. "But when they are doing the process by themselves what could ultimately happen is setting themselves up for further medical complications by purchasing products that don't support them or provide pressure management where it's necessarily or (they could) actually obtain the wrong mobility base itself."
If you're worried about those complications, working with a good mobility provider might be your best option.
"Our profession is part of the medical model that ensures the clients that we provide services to that we are concerned with their outcomes and life to make sure that they are as independent as they can be within whatever their functional means are," Stewart says. "I'm sure that just about any CRTS or ATP that you'll talk to, definitely there's a passion to provide the equipment to those clients that we service."
How to Select an Equipment Provider
If you've been burned by a bad mobility provider in the past, you might be wondering where to find these so-called “good providers.” While there's no fool-proof way, there are some things you can consider to help you make a good decision.
First up, when looking for complex mobility equipment with specialized functions and customization, look for credentials: ATP and CRTS.
ATP stands for assistive technology professional and is a credential offered by the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA). CRTS, which stands for complex rehabilitation technology specialist, is a certification offered by the National Registry of Rehabilitation Technology Suppliers (NRRTS). These credentials show that your provider has completed training and become certified to assist you in purchasing mobility equipment.
Providers, however, don’t currently have a credential available to them for less complicated mobility equipment, such as non-customized power chairs and manual chairs, canes, crutches and walkers, says Simon Margolis, executive director of NRRTS. In those cases, Margolis recommends relying on good, old-fashioned word of mouth.
"Even within that group of CRTSs and ATPs, they're not all created equal," Margolis says "I think that one of the best ways of choosing is to have contact with other consumers who have had experience with these suppliers. That's not always the only way to measure stuff, but it is certainly a way to gain some insight into how long the process took, how responsive the individual was, were changes made in a timely fashion, was there any problem with billing, was there any issue with long delays in actually receiving the equipment."
He also recommends working with your therapist/clinician for advice on which companies offer the best service.