Aquatec Ocean

Height-adjustable shower commode chair. 24" or 5" wheels.

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Did you Know?

Stem Cells

We hear about them on the news, we listen to politicians argue for and against them.
Inside an embryo no bigger than the period at the end of this sentence are dozens of stem cells. Initially, these cells are blank slates, meaning that their fate is undecided. But they have great potential. Stem cells are pluripotent, which means that they can develop into every cell, every tissue, and every organ in the human body.

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Will Medicare help with your purchase?
Understanding Medicare Standards

This page is intended to share some of the questions we receive regarding what is covered by Medicare and various reimbursement methods.  Use the links to the left of this page for further information regarding Medicare.
 
Medicare is the federal health insurance program for people age 65 or older.  It also covers certain younger people with disabilities and people with End-Stage Renal Disease.  Medicaid is not the same as Medicare. Medicaid is a joint federal and state program that helps with medical costs for some people with low incomes and limited resources.  Coverage varies from state to state.  A person may have both Medicaid and Medicare. We do file Medicare claims, but we do not file Medicaid.
 
Knowing about deductibles, coinsurance, and co-payments also can help you understand Medicare Billing.
The deductible is the amount that a person must pay for health care before Medicare Part A or Part B begins to pay.  These amounts can change every year.
Coinsurance is the percentage (usually 20%) of the Medicare approved amount that the person has to pay after paying the deductible for Part A and Part B.
A co-payment is a set amount the person pays for each medical service, like a doctor visit.  Medicare + Choice plans might also require co-payment.
 
We file Medicare claims for Internet sales on a non-assignment basis.  Non-Assignment means that you pay for the product up-front.  We complete the necessary paperwork and submit it to Medicare on your behalf.  When filing on non-assignment, Medicare reimburses the beneficiary directly.  You pay the full amount up-front.  If you have secondary insurance you may contact them for filing procedures.  In some cases Medicare automatically submits the claim to the secondary carrier.
 
The most common question we receive is "why won't Medicare cover the cost of what I need to perform my daily routine?"  Medicare's coverage is limited to products required to help you get around your residence.  They don't cover products for you to go to the mall, doctor's office, or to visit a neighbor.
 
Use common sense.  Medicare will not cover a product just because your doctor wrote you a prescription.  A prescription is just the first step of a series of criteria for Medicare eligibility.   
 
Be practical, Medicare does not pay for luxury items when a basic product will work.  In many cases, the supplier makes the decision on which product to supply you.  You can not get a Titanium wheelchair when a basic standard weight chair will do.  You can not get a 4 wheel scooter because it's better in the backyard.  You can not get a Transport wheelchair for outings.
 
Medicare has some simple rules for reimbursement qualifications.  Take them literally - they are not flexible.  We receive numerous calls daily asking if Medicare will be a little more flexible since...  NO - THEY ARE NOT FLEXIBLE STANDARDS.  Read the requirements for each product to see if you qualify.  Remember, abuse is what made the Medicare system tough.  Products are approved only when the patient cannot function without it, not when the product would make the patient's life easier or more comfortable.
 
Please don't ask a supplier to submit a claim so you can receive a denial from Medicare.  If you need a denial for your insurance company, get educated and do it yourself.  A supplier that submits a claim for which they know has no basis is simply filing a fraudulent claim.
 
Medicare has set reimbursement amounts for products.  They reimburse 80% of that amount.  Your insurance may or may not pay the remaining 20% of that reimbursement amount.  You are responsible for the remainder if any.  Dealers or suppliers that tell you that there is no out-of-pocket are committing fraud - it's illegal to tell you that.  Only under special circumstances can the supplier "write-off" any remaining cost due to a hardship situation. 
 
Some products are "capped rentals."  Manual wheelchairs, beds, and Hoyer Lifts are good examples.  Medicare pays the monthly rental of these items for a predefined term, it's not a purchase.  When the rental period has expired you may have an option to purchase the product or continue paying the monthly rental yourself.  In the situation of a rental, Medicare pays 80%, you are responsible for the remainder.
 
We file Medicare claims as a courtesy to our Internet customers.  We process the claims in a timely manner.  Sometimes there are delays in various stages of the processing cycle.  Most are caused by the physician's failure to return a CMN form, or failure to read the instructions.  Missing diagnosis codes, signatures, and incorrect answers to questions on the form are usually to blame for slow reimbursement.  Many times we make several attempts to obtain missing forms back from the doctor. 
 
If you have questions regarding coverage and requirements, call Medicare at 800-MEDICARE.  Medicare also maintains a website: www.medicare.gov.  Be an educated consumer.  Don't just simply rely on what someone else told you.  Find out how the system works for yourself.
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