Our Frequently Asked Questions (FAQs):
Yes, Items are available for rent most insurance providers will allow more certain items to be billed as a rental.
Medicare will allow you to rent durable medical equipment for 13 months. Equipment is billed as a capped rental item. After Medicare pays 13 months the ownership is transferred to the beneficiary.
A prescription, your physician must write a prescription for us to bill medical equipment through insurance. Depending on the equipment being requested the physician may need to complete and sign a Certificate of Medical Necessity (CMN), or a form that describes the nature of your condition, we might need additional clinical records to support medical necessity.
Your physician’s office can send an order for equipment and supplies to us. It can be faxed to 773-886-1642 or email to [email protected], we may ask for additional clinical notes.
You can fax 773-886-1642 or email [email protected] us the following information:
• Full legal name of patient, address, phone number.
• Physician’s order for desired equipment, which must include: •Physician’s name and NPI number, patient’s diagnosis, estimated length of need for equipment.
• Most Recent office note
• Patient’s insurance information.
• Patient’s date of birth.
• Patient’s height & weight.
Medicare Part B helps pay for durable medical equipment, including;
• manual wheelchairs (capped rental item) see rental equipment below
• power wheelchairs (reimbursable item)
• some positioning devices
• walkers (some heavy-duty rollators)
• seat-lift mechanisms for lift-chairs
• mattress over-lays
• hospital beds (semi-electric only)
• oxygen equipment
• artificial limbs
• orthotics (splints)
Durable medical equipment such as wheelchairs are covered if it is deemed medically necessary.
Equipment not covered by Medicare includes; adaptive daily living aids such as: reachers, sock-aids, utensils, transfer benches, shower chairs, raised toilet seats, and grab bars.
Medicare does rent and will pay for a manual wheelchair, Medicare will on occasion, pay for a motorized unit as well. Although it is not guaranteed that you will qualify or be reimbursed by Medicare, whether you personally lay out the price for one, or are looking for Medicare to purchase one for you, we can give you some guidelines to follow and the basic criteria that must be met in order for Medicare to either reimburse or authorize payment for a motorized unit. A power wheelchair is covered when all the following criteria are met:
• The patient’ s condition is such that without the use of a wheelchair the patient would otherwise be bed or chair confined.
• The patient’ s condition is such that a wheelchair is medically necessary and the patient is unable to operate a wheelchair manually.
• The patient is capable of safely operating the controls for the power wheelchair. A patient who requires a power wheelchair usually is totally non-ambulatory and has severe weakness of the upper extremities due to a neurological or muscular disease/condition. If the documentation does not support the medical necessity of a power wheelchair but does support the medical necessity of a manual wheelchair, payment is based on the allowance for the least costly medically appropriate alternative. However, if the power wheelchair has been purchased, and the manual wheelchair on which payment is based is in the capped rental category, the power wheelchair will be denied as not medically necessary. Options that are beneficial primarily in allowing the patient to perform leisure or recreational activities are non-covered.
A power operated vehicle (POV) is covered when all the following criteria are met:
• The patient’s condition is such that a wheelchair is required for the patient to get around in the home.
• The patient is unable to operate a manual wheelchair.
• The patient is capable of safely operating the controls for the POV.
• The patient can transfer safely in and out of the POV and has adequate trunk stability to be able to safely ride in the POV. Most POVs are ordered for patients who are capable of ambulation within the home but require a power vehicle for movement outside the home. POVs will be denied as not medically necessary in these circumstances. A POV that is beneficial primarily in allowing the patient to perform leisure or recreational activities will be denied as not medically necessary. If a POV is covered, a wheelchair provided at the same time or subsequently will usually be denied as not medically necessary.
Only the seat lift mechanism on a lift chair could be considered medically necessary if all the following coverage criteria are met:
• The patient must have severe arthritis of the hip or knee or have a severe neuromuscular disease.
• The seat lift mechanism must be a part of the physician’s course of treatment and be prescribed to effect improvement, or arrest or retard deterioration in the patient’s condition.
• The patient must be completely incapable of standing up from a regular armchair or any chair in their home. (The fact that a patient has difficulty or is even incapable of getting up from a chair, particularly a low chair, is not enough justification for a seat lift mechanism. Almost all patients who are capable of ambulating can get out of an ordinary chair if the seat height is appropriate and the chair has arms.)
• Once standing, the patient must have the ability to walk. Coverage of seat lift mechanisms is limited to those types which operate smoothly, can be controlled by the patient, and effectively assist a patient in standing up and sitting down without other assistance. Excluded from coverage is the type of lift which operates by spring release mechanism with a sudden, catapult-like motion and jolts the patient from a seated to a standing position.
Coverage is limited to the seat lift mechanism, even if it is incorporated into a chair. Medicare does not cover the full cost of the chair.
We order lift chairs from Golden Technology, please go to their website to pick a model. Once you have selected a model contact us and we can give you a price quote.
Medicare does not reimburse nor authorize the purchase of a lift for a wheelchair or scooter currently. Such items are typically not considered a medical necessity because they can also be used by persons without a medical condition. Don’t forget, Medicare covers items needed “inside” the residence.
When your deductible is met, you’re still responsible for paying directly, or through supplemental insurance, at least 20 percent of the Medicare approved amount. This co-payment may not be dropped by the supplier except in very special hardship situations and only on a case-by-case basis. A supplier who routinely drops the co-payment may be violating federal law.