Roho Cushion Qualification: How To Get Approved
Jun, 18 2025
Roho cushions aren’t just another seat cushion—they’re a big deal for anyone who uses a wheelchair or struggles with pressure sores. Designed to help people sit for long periods without skin breakdown, these cushions can make a huge difference in someone’s comfort and health. But the big question is: how do you actually qualify to get one covered?
If you’ve heard about Roho cushions from a therapist, or you know someone who swears by them, you might be wondering if you even meet the requirements. Here’s the deal: eligibility usually centers around medical necessity. That means you need to prove—through notes from your doctor—that you have a real risk of developing pressure injuries, or you already have one. No, just wanting a comfier seat isn’t enough for insurance or Medicare to foot the bill.
Tip: Start collecting your paperwork early. Doctors’ notes, therapist evaluations, even photos of wounds (if you’ve got them) can help make your case. The more proof you can show, the better your odds of approval. I’ve literally seen people get denied for missing a single line on the physician’s note, so don’t leave details to chance.
- What Is a Roho Cushion and Who Needs One?
- Medical Necessity: What Counts and What Doesn’t
- Paperwork and Prescriptions: Navigating Documentation
- Getting Insurance Approval: Pro Tips for Success
What Is a Roho Cushion and Who Needs One?
Let’s break it down: a Roho cushion is a special wheelchair cushion filled with interconnected air cells. These air cells move and shape themselves to the user’s body, which means less pressure on any one spot. That’s huge if you’re stuck sitting for hours or have trouble feeling when something’s wrong with your skin. The main goal? Prevent painful pressure sores, also known as pressure ulcers or bedsores.
Roho cushions don’t just make things comfier—they can be a literal lifesaver for people with serious mobility issues. They’re most commonly recommended for folks who:
- Use a wheelchair full-time, especially if mobility is limited or sensation is reduced
- Have had pressure sores before, or are at high risk because of conditions like spinal cord injury or multiple sclerosis
- Struggle to shift their weight on their own
- Need advanced skin protection that's tough to get from cheaper or foam cushions
Here’s a quick look at how Roho cushions perform versus regular seat cushions:
| Cushion Type | Average Pressure Re-distribution | Recommended For |
|---|---|---|
| Roho Cushion | High | High-risk users, previous sores, limited mobility |
| Foam Cushion | Moderate | Low-risk users, short-term use |
| Gel Cushion | Moderate | Low-to-medium risk, comfort needs |
Something you might not know: according to a 2022 study in the Journal of Rehabilitation Research, users of Roho-style air cushions saw a 60% reduction in severe pressure injuries compared to those using basic foam cushions.
The authority on this stuff is the National Pressure Injury Advisory Panel (NPIAP). They put it simply:
"Air-cell-based cushions like the Roho have shown the highest effectiveness in reducing pressure ulcer incidence in at-risk wheelchair users."
So, if you or someone you care for is in a wheelchair and worried about skin issues, a Roho cushion could be more than just a comfort upgrade—it could really protect your health and independence.
Medical Necessity: What Counts and What Doesn’t
Insurance companies and Medicare aren't playing around when it comes to approving a Roho cushion. They’re laser-focused on the concept of “medical necessity.” In the simplest terms, this means your doctor must prove you’re at real risk of skin breakdown or already dealing with pressure sores—also called pressure ulcers or decubitus ulcers.
Here’s what typically counts as medical necessity for a Roho cushion:
- You have a current, documented pressure sore on your butt, tailbone, or sitting area (Stage II or higher gets their attention fast).
- You’ve got a health issue or disability (think spinal cord injury, MS, severe diabetes, or paralysis) that makes it hard to shift your weight or sense pain.
- You’re unable to walk, so you spend most of your day in a wheelchair (usually six or more hours).
- You’ve tried other surfaces—like foam or gel cushions—and gotten zero improvement.
Insurance ignores comfort claims. Saying, “My old cushion is uncomfortable” won’t cut it. They also won’t approve just because you use a wheelchair—they want evidence of actual skin risk or breakdown. Here’s a quick look at what counts and what doesn’t:
| Counts As Medical Necessity | Doesn’t Count |
|---|---|
| Stage II+ pressure ulcer | Minor redness or irritation only |
| Diagnosis affecting sensation/mobility (SCI, MS, severe diabetes) | Occasional discomfort (no diagnosis) |
| Failed trial of other cushions | Haven’t tried alternative cushions |
| Wheelchair-bound for most waking hours | Walks most of the day |
Your healthcare provider needs to write detailed notes. Here’s a typical example of what really helps in an insurance review:
“When documenting medical necessity, use precise language. State the patient’s diagnosis, mobility status, and wound history. Outline all failed interventions. Generic statements don’t work.” — Dr. Maurice Bianchi, Rehabilitation Physician
Double-check if your insurance needs specific photos, wound measurements, or forms. Missing one record could set back the process by weeks. Each company (and even state Medicaid plans) may have unique paperwork. Stay in close contact with your provider and document everything.
Paperwork and Prescriptions: Navigating Documentation
This is where things get a bit sticky for most people looking to qualify for a Roho cushion. Insurance companies and Medicare have a checklist, and they rarely budge if you miss a step. First thing to remember: you can’t just walk into a store and pick up a Roho cushion with a smile and a story. You need the right paperwork—usually from a doctor or a therapist who knows your medical needs inside out.
Your paperwork should clearly state why you need the cushion. The doctor’s note has to show either you already have a pressure ulcer (stage II or higher), or you’re at high risk for getting one. Just saying “patient uses a wheelchair” isn’t enough. The details matter here: your daily sitting time, your history of skin breakdown, what kind of help you get at home, and even whether you can shift yourself in your chair.
Here’s what you usually need to have lined up:
- A complete prescription from your doctor, specifically naming a “pressure relief wheelchair cushion” and ideally the Roho brand if that’s recommended.
- A face-to-face exam note (yes, actual in-person notes are almost always required) where your doctor talks about your condition in detail—skin integrity, risks, and sitting habits.
- A supporting letter or evaluation from your physical or occupational therapist isn’t always required but can help move things along. Therapists have a knack for spelling out the details that insurers want to see.
- Recent photos, if you already have a wound. Some insurers want proof, and this can save a ton of back-and-forth.
Don’t forget, all documents need to be signed and dated, and details need to match—insurance companies check dates and wording with eagle eyes. A missing signature or an off-hand mention of a "soft cushion" instead of a medical-grade one can get your claim tossed fast. Ask for copies of everything and double-check that what goes to insurance actually fits what’s asked for in their policy. Most denials come from paperwork that’s incomplete or too vague, not because someone isn’t truly in need.
Getting Insurance Approval: Pro Tips for Success
Getting approved for a Roho cushion feels a lot like trying to win at bureaucracy bingo. But if you get the details right, you’ll have a much easier time. Here’s what’s really going on behind the scenes when insurance companies look at your request.
First, they’re checking if your case ticks all the medical boxes: do you have an actual pressure sore, or does a doctor think you’re at high risk? Medicare’s rules are pretty specific. According to the National Pressure Injury Advisory Panel, up to 2.5 million patients in the U.S. develop pressure injuries every year. That’s a lot of people—so insurers want real proof that you’re at risk, not just uncomfortable.
Here's what can speed things up:
- Make sure your doctor writes down your exact diagnosis and why a Roho cushion is medically necessary. The words "at risk for skin breakdown" or "current stage II pressure ulcer" make a difference.
- Include all supporting documents—doctors’ notes, therapist recommendations, and discharge papers if you’ve been in a hospital or rehab center.
- If you can, get an occupational or physical therapist to measure you for the cushion and add their expert recommendation. Therapists’ notes carry real weight with insurance.
- Double-check that all your paperwork matches. One mismatched date or skipped signature can stall everything for weeks.
It helps to know that insurance companies reject 10-20% of claims for pressure relief cushions on the first try—often just due to missing details, not medical issues. If you get denied, you can usually appeal. Just fix what was missing or unclear and resubmit. Persistence pays off with this stuff.
| Step | Average Success Rate | Delay If Something's Missing |
|---|---|---|
| Complete application first time | 80% | 1-2 weeks |
| Missing documentation | 40% | 3-6 weeks |
Want a little expert wisdom? A lot of clinics say the same thing, but this quote from Mobility Management gets right to the point:
"Detailed documentation is the number one reason claims get approved or denied. The more specific, the better."
If your Roho cushion really is a medical need, don’t give up—call your doctor’s office, reach out to your clinic, and push for every form and signature. It makes a difference, and you’ll end up with the right support under you.