Shuffling through the Medicare maze to get your Medical Equipment

I have visited my doctor and he has given me a script for medical equipment. Now, all I need do is to present it to the medical supply house and I will leave with the equipment today, correct? Well, not exactly! So now what happens? First, you call or visit a medical equipment supplier and ask whether they carry the item(s) that you need. Then, you ask whether it is a Medicare covered item. If it is, then you might qualify for the item(s) under Medicare depending upon your specific situation and documentation. Then, you ask whether they accept insurance. You want them to specify whether they accept assignment or not. If they accept assignment, then you may not have to pay any money up front for your supplies as the medical equipment supplier will bill Medicare on your behalf and you will assign the benefits to that supplier who will collect the payment from Medicare. If you go to a supplier who does not accept assignment, then, you will have to pay them up front and, if your claim is approved, wait to get reimbursed. They should complete and file the paperwork on your behalf.

So, you have now determined that the medical supply house has the item(s), that they accept Medicare, and that you want that item(s). The medical supply house will fax a Physician’s Order or, a Certificate of Medical Necessity to your doctor’s office for the item(s) with a cover letter requesting all notes from your chart that support the need for the equipment prescribed by your doctor. They will complete the forms and fax the information back to the supplier, who will then determine under Medicare guidelines that your claim will be accepted and approved. If so, the equipment will be issued to you at that time.

Next month we will further explore the Medicare conundrum including deductibles, prior claims and other pieces to the puzzle.