FIGHTING MEDICARE trying to get coverage
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April 11, 2007 at 7:11 pm
Hello,
I could use some help, or at least someone to tell me not to give up. I am trying to get medicare to cover a power wheelchair. I submitted a claim and they haven’t refused, but they are demanding more information. I think this is what they want……the ICD-9 code for suppliers……what is this?…….Will my doctors office know what it is?The letter I got from medicare also says:
Ln Numb Place of Proc Service Dates Submit Provider
No Serv Service Code From To Charge NameIs that more information they want.
I wish my dad was alive. I’m not smart about these things and he was brilliant about getting them done.
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April 11, 2007 at 7:42 pm
Liz I found a sample information on the internet that might help you. Sorry I am from Canada so I don’t know the stuff from Medicare
Sue
Your Medicare Number should match the number on the beneficiary’s Medicare card.
Name and Address. If the beneficiary’s name and address are incorrect on the MSN, they should contact both the
Medicare carrier and the Social Security Administration immediately.Dates of Service shows when the supplier provided the service(s) listed. These dates should compare with the dates
shown on the supplier’s bill.Each claim is assigned a Claim Number, which the beneficiary may provide when calling the Medicare office about the
MSN.
Services Provided is a brief description of the service or supply, the number of services and service code.Amount Charged is the charge submitted to Medicare by the supplier of service(s).
Medicare Approved is the amount Medicare approved for the service(s) received.Medicare Paid Provider. In most situations, Medicare pays 80 percent of the approved amount after subtracting any
unmet portion of the annual deductible. For unassigned service(s), this column is titled Medicare Paid You.
You May Be Billed. This is the total amount the supplier is allowed to bill the beneficiary. It combines the deductible,
the coinsurance and any non-covered charges. If the beneficiary has supplemental insurance, it may pay all or part of
this amount.
See Notes Section. If a letter appears in this column, the beneficiary should refer to the Notes Section.
The Supplier’s Name and Address is displayed on the MSN. The address shown is the billing address which may be
different than where the services were received.
The Notes Section gives more detailed information about the claim.
Deductible Information shows how much of the beneficiary’s annual Medicare deductible has been met.
General Information provides important Medicare news and information.
Appeals Information such as how and when to request an appeal, is shown here. -
April 11, 2007 at 7:47 pm
Also maybe the ICD-9 Code is the code referring to medical problem that requires you to get the power wheelchair. I think each medical problem has a code which their computer identifies with.
Sue
Good luck
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April 11, 2007 at 7:48 pm
I’m not familiar with Medicare at all but could they be asking for some kind of number given to the power wheelchair company…like some kind of billing number or code.
Do they give you a number to call & reach someone to ask them? I wish that our government stand up for our citizens & make the documents in PLAIN ENGLISH so everyone that needs benefits can get them.
Good luck.
Kelly -
April 11, 2007 at 8:13 pm
Hi Liz,
The CPT code is the procedure code that the doctors use for any procedures they do with you or to you you.
The ICD code is the diagnosis code, again the Drs have to put that on whatever papers you are filing with Medicare.
There is also place of service codes, no bills can be submitted without any of these 3 codes or they will be denied, the Dr has all of those codes. Some of the codes have what are called modifiers that go with certain codes.
If the Drs also put down the wrong codes the claims will be denied.
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April 11, 2007 at 8:45 pm
It sounds like I have to get the ICD-9 diiagnosis code from my doctors office and not the medical supplier. I will be calling the doctors office tomorrow and I will ask to talk to someone who is familiar with medicare codes.
When I sent in the durable medical equipment claim form to medicare (and I paid attention and did send to right adddress) I included a copy, back and front, of both my medicare card and my secondary card. My social security number was always my ID number, but lately I’ve noticed a different ID number on summarys. So I submitted both my social security ID and the new number. I have 30 days to send medicare what they want.
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April 11, 2007 at 8:57 pm
Hi Liz,
Could the power chair company help you with the paperwork? I think I have heard advertisements where they say they will help you get your power chair for free — I assume by helping complete your claim paperwork. It never hurts to ask 🙂Good luck!! Let us know how you turn out!
Leanne
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April 12, 2007 at 12:07 am
[COLOR=red]Medicare bought my chair w/o any problems, but I am a quadriplegic so I don’t think my case is the same.[/COLOR]
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[COLOR=#ff0000][IMG]http://img172.imageshack.us/img172/9066/daveoldenginesq3.gif[/IMG][/COLOR] -
April 13, 2007 at 12:25 am
Hi Dave,
Didn’t you say awhile back that Medicare was cutting back the cost for power chairs by 41%? I can’t believe what they are doing.
I hope Liz gets her chair.
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April 13, 2007 at 9:04 am
don’t give up Liz! its just a bunch of paperwork, nothing to stres over. one day at a time! your drs’ office will know what to do and for that matter the powerchair company knows what is needed also, if they are able to file your claim-let them do it-you just need to sit back and let them do the work.:)
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April 13, 2007 at 9:32 am
It is the PRINCIPAL of the thing right now!!!!!!!!!!! I’ll explain more about what’s going on. I bought (out of my pocket) a small power chair about six months ago from a medical supply dealer in my area. I chose to do this because I wanted a power chair that would meet my needs and I had to be able to see it and test drive it. I know that there are many dealers, you find them on the web and see them on TV, who do the paperwork and get medicare coverage, but I needed to see the scooters/bigger power chairs/ folding power chairs/ small lighter power chairs before I bought. The medical supply store I went to showed me a PRIDE GO CHAIR, which met my needs. The store salesman told me it was not approved by medicare and they insisted that it was useless to even try to apply for coverage, so I did not. I’m the kind of person who thinks of things “after the fact” and this was well after the fact. I FOUND OUT THAT MY SECONDARY INSURANCE “WOULD” COVER THE POWER CHAIR. The medical supply store must have thought I only had medicare. I AM TRYING TO GET MEDICARE TO DENY THE CLAIM I SUBMITTED, then they will forward their denial to my secondary insurance to see if they will pay. MEDICARE MUST SHOW MY SECONDARY THAT THEY DENIED COVERAGE, I could not submit directly to secondary.
IT IS THE PRINCIPAL OF THE THING. MEDICARE SHOULD NOT DENY ANY COVERAGE ON ANY POWER CHAIR WHEN SOMEONE WHO CANNOT WALK NEEDS IT. The mouse (me), must become a lion (voice) and roar.
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April 13, 2007 at 10:59 am
Good thinking Liz!! You Go Girl!!!:D Lets hear that mighty ROAR!! i agree no one should be denied a powerchair when they need one.
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April 13, 2007 at 10:31 pm
I agree wholeheartedly!! Anyone who needs a power chair should definitely be covered for one. Go get ’em Liz!!
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April 13, 2007 at 11:57 pm
[COLOR=red][QUOTE][B]Medicare cuts payments on power w/c 11/15/06, FYI
[/B][COLOR=red][B]”On October 2, 2006, CMS published its new Medicare payment amounts for power wheelchairs – and the news is grim for those with disabilities. Effective November 15, 2006, CMS will slash what Medicare will pay for a power wheelchair by up to 41%.”
[/B][/COLOR][/QUOTE][/COLOR]
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[COLOR=#ff0000][/COLOR][COLOR=#ff0000]From what I’ve been told Medicare is really cracking down on “handing out” power wheelchairs. You have to demonstrate on need for one to get around in your home. Medicare does not care about work or anything outside the home. If you can use a manual chair inside your home enviroment, forget about a power chair.[/COLOR]
😡
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April 14, 2007 at 11:27 am
[B]Thanks for the info Dave.[/B] 🙂 🙂
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June 5, 2007 at 10:08 am
Hello Family,
I know that I need this to be a VENT and I do feel ANGRY! Today, after a talk with medicare, I have to give up and probably write off the cost of the power chair I bought, as a loss. Some of you know how much that is. Going back to the beginning, I bought the power chair myself because the local medical dealer I went to told me it was useless to send in a claim, medicare wouldn’t cover the chair I wanted. And I didn’t want to order off the internet, I wanted to see the power chair first and drive it. I wanted to look at different kinds. It took me six months to realize that I should try anyhow. If medicare refused payment, my secondary insurance would cover it. I sent in the forms and paperwork myself. The medicare rep. I talked to said that this is “unheard of”, he kept repeating that it takes a “professional” to fill out the paperwork. The “professional” (medical store dealer) told me it was useless to fill them out. Yes, I failed to make copies of all the papers I was sending medicare, but I go through alot with this syndrome and I stress out alot, it’s not possible for me to be able to remember everything. The medicare rep. was faulting me for not making copies, I WAS ANGRY. I told him he should live with the sensations that I feel and then see how well he remembers to do everything.The bottom line is that I’d have to try to get out and get another sales receipt from the medical dealer and then try to get another letter from my doctor that a power wheelchair is necessary and that’s not so easy when you don’t have transportation. And my secondary insurance may also refuse to pay because I’m filing myself.
The only good news is that I do learn.
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June 5, 2007 at 11:00 am
Hi Liz, When I got my Jazzy power chair, the company I ordered from told me since I had a standard wheel chair, through Medicare, they would not pay for the Jazzy. I use both chairs (not at one time:D ) so I didnt argue. Took money from our retirement and bought it. I was worth it, I can go anywhere.
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June 5, 2007 at 1:30 pm
Liz,
I can understand your fustration dealing with a government agency. I have to deal with the Air Force and the VA.Even though it is fustrating the just thought of beating at their own gain can make it all worth while. 😀 Hang in there and keep on fighting and when you get too fustrated, just vent here. There are plenty of people here who understand what you are going through.
Jim C
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June 5, 2007 at 3:26 pm
Hi,
The ICD-9 is the diagnosis code. The code for CIDP is 357.81. I’ve had to tell the lab people I don’t have C-O-PD, C-I-PD, so I learned the code. It’s so rare they’ve never heard of it.:D
Cathy
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June 5, 2007 at 6:25 pm
Liz,
I’mso sorry you are tied up in needless red tape over your chair. Would it be possible to have your doctor and the company where you bought the chair fax or scan/email, snail mail, or courier the receipt and paperwork you need, instead of making you go get it?
Best of luck in getting this reimbursed- I bet you’ll do it.
As always, Suzanne
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