Monday, December 26, 2011

Medicare Mobility Scooter - Two Conditions That Will Get You a Medicare Paid Scooter

!±8± Medicare Mobility Scooter - Two Conditions That Will Get You a Medicare Paid Scooter

After you have dealt with Medicare for a while, you probably realized that, dealing successfully with Medicare requires patience and following the Medicare rules and procedures. Come to think of it, isn't that the case with most government programs. Sure, nothing surprising here.

And if you are mobility challenged and are looking to get a new mobility scooter to expand your range of mobility and increase your self-reliance, you may be wondering what it will take for Medicare to reimburse your expense to get that Medicare mobility scooter. In particular, you may be wondering if your condition is such that it complies with the Medicare criteria for the mobility scooter reimbursement.

You are in the right place if this is what you were wondering about. You will find description of the two most commonly cited conditions that will likely get you a medicare paid scooter. When you are done reading, you can check further if your condition is the same or similar, and you will know whether it is worth it to pursue the reimbursement strategy. Mobility scooters can be quite expensive! The two medical conditions that are most frequently cited as reasons for Medicare approving the reimbursement for a mobility scooter are: COPD and Arthritis. Let's look at them in detail.

COPD

COPD stands for Chronic Obstructive Pulmonary Disease. It simply means that the breathing pathways have been obstructed and that you are having a hard time breathing because of that. When the lungs do not get sufficient oxygen due to the obstruction, the blood does not get saturated with the oxygen sufficiently. All of our body cells need oxygen to generate energy for their regular activities. As a consequence of the lack of oxygen, the body cells stop functioning properly. Of course, our leg muscles are some of the largest parts of our bodies. We may have a lot of difficulties just walking after a few steps when we have a severe COPD. The lack of energy for walking can make it difficult or impossible even to use a cane, a walker, or even a manual wheelchair. Yet you might still have enough energy to get on and off a mobility scooter and operate it safely. Incidentally, these are the most important conditions that Medicare looks like when deciding to approve your mobility scooter application.

Arthritis

Arthritis is a severe joint inflammation. When arthritis attacks our hip joints or our knee joints, we may feel the pain even when we are not walking. However, when walking the pain can become stronger, even unbearable. The inflamed joint is subject to greater pressures when walking which in turn makes the inflammation and its symptoms and consequences worse. So sometimes, walking across the room can be painful. Yet, taking a few steps to get to the mobility scooter and getting yourself seated you can still do. Again, these are the conditions Medicare looks at when they are deciding about approving your mobility scooter application.


Medicare Mobility Scooter - Two Conditions That Will Get You a Medicare Paid Scooter

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Tuesday, December 6, 2011

Top Five Tips for Submitting Insurance Reimbursement of a Crutch Alternative

!±8± Top Five Tips for Submitting Insurance Reimbursement of a Crutch Alternative

Dealing with insurance companies can often be an overwhelming and frustrating process. Planning ahead of time can ensure you get the full benefits you deserve with a minimum delay. Key areas to consider include:

1. Pre-Approval

Some plans require pre-approval. This can be done by calling your insurance company and asking if they cover crutch alternatives. They will most likely ask for the H.C.P.C.S. (pronounced "Hics Pics") code. The generic code of a crutch alternative is "E0118". They may also ask for the diagnosis code or the procedure code. You can get this from your health care provider as it is specific to your condition.

If your insurance does cover the device, make sure to ask what percentage is covered and if you are required to get it from an in-network provider?

2. Other Options

Like all rules there are exceptions, so make sure you find out about the following:

- If none of the in-network providers carry the crutch alternative you need, you might be able to request an exception from your insurance company to allow you to go out of network.

- If you have a Flex Spending Account, crutch alternatives DO qualify as a medical expense. Some Flex accounts issue a Visa/MasterCard debit card that can be used.

- If you itemize your deductions on your taxes, you may be able deduct the rental/purchase of your crutch alternative as a medical expense (consult your tax professional for advice).

- If a crutch alternative allows you to return to work, your employer may pay for the rental/purchase.

- If you are willing to pay out-of-pocket for a crutch alternative because you can not imagine another day on crutches, the expense is often worth the freedom and mobility you will gain. Especially if you can heal faster because you are compliant with doctor's orders or because you can continue working.

3. Claims

Complete the insurance form which can usually be found online or sent to you by your insurer. Be sure to include a copy of:

1. Paid receipt

2. Your prescription

3. a completed Letter of Medical Necessity signed by your Physician

This may seem redundant, but if both are not submitted, your claim may be immediately denied. If you are renting, you may want to wait until you have returned your product and the final charges have been made. This way you will only have to submit one time. Make copies of everything you submit to your insurance company, just in case you need to re-submit!

4. Follow-up

To ensure nothing gets delayed, you may want to follow-up with a phone call to confirm that your claim was received and there is nothing more needed.

5. Appeals

If your insurance company denies the claim, you have the right to appeal. You can re-submit your claim and/or have your HR contact at work call the insurance company on your behalf. Any notes or documentation may be very helpful at this point. At every stage, document who you talked with, when you talked, and about what. It is much easier and affective to appeal with facts.


Top Five Tips for Submitting Insurance Reimbursement of a Crutch Alternative

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