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Thread: Medicare supplement copayment?

  1. #11
    RDF - there is still a 20% copay but you are correct that many suppliers will waive this. I guess they decided that having clean catheters will eliminate many very expensive hospital stays for urosepsis (kidney infection). Provide more catheters, less hospitalizations, less total cost. It is one instance that policy makes good sense.... okay off to watch football.

  2. #12
    Super Moderator Sue Pendleton's Avatar
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    OK, my 2012 book got packed. Now that we're retired I'm trying to get everything covered I can. Will Medicare cover 4 foleys a month plus extension tubes and bags? From the very first I never had much luck going by the 3 week rule the urologists tend to go by. As long as I change weekly I seem to avoid most utis and the expensive antibiotics.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  3. #13
    Quote Originally Posted by Sue Pendleton View Post
    OK, my 2012 book got packed. Now that we're retired I'm trying to get everything covered I can. Will Medicare cover 4 foleys a month plus extension tubes and bags? From the very first I never had much luck going by the 3 week rule the urologists tend to go by. As long as I change weekly I seem to avoid most utis and the expensive antibiotics.
    no. i get 1 foley/month. my doc even documented i needed to change every 2 weeks due to uti. still in the process, medicare still denying. i have had more utis since i've been on medicare than any other time in my 26 yrs of paralysis. eta: my dme has provided me 2 foleys/month last 3-4 months, but i will be charged as i keep getting medicare letters saying this is denied.

    i also can't get my urocare legbags or my usual 4 nightbags/month. it's not a good situation and i'm still fighting.
    Last edited by cass; 02-06-2012 at 12:30 AM.

  4. #14
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    So I have not had any experience on the DME side of medical billing but....it appears what is covered and how many depends on what state you live in. It is the same in the hospital. A test may be covered in one state but not in another.

    Here is an example of a Local Coverage Determination:

    http://www.medicarenhic.com/dme/medi...PA_2011-02.pdf

    and another:

    http://apps.ngsmedicare.com/applicat...ontentID=34371

    There are locals which vary by geographical area and there are national Coverage Determinations which don't vary and are standard everywhere in the US.

    The commercials on TV for diabetic testing supplies and urological supplies depends on where you live as to what Medicare will pay for.

    If I can determine who the FI is that handles Medicare claims where you live Sue....I can answer your question. The Fiscal Intermediary (FI) will be shown on one of your EOB's (explanation of benefits) that you get from Medicare after you have been billed by your doctor.
    Last edited by darkeyed_daisy; 02-06-2012 at 01:21 AM.
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  5. #15
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    Quote Originally Posted by rdf View Post
    Wasn't there a new law passed that one could get 200 catheters per month if on Medicare? I've heard many people say there was no 20% copay. Maybe they were mistaken.
    You are right. Here is the bulletin sent out by Medicare that clarifies:

    http://www.medicarenhic.com/dme/medi...etter_0210.pdf

    I am still researching the copay.
    Last edited by darkeyed_daisy; 02-06-2012 at 12:58 AM.
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

  6. #16
    Super Moderator Sue Pendleton's Avatar
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    Quote Originally Posted by cass View Post
    no. i get 1 foley/month. my doc even documented i needed to change every 2 weeks due to uti. still in the process, medicare still denying. i have had more utis since i've been on medicare than any other time in my 26 yrs of paralysis. eta: my dme has provided me 2 foleys/month last 3-4 months, but i will be charged as i keep getting medicare letters saying this is denied.

    i also can't get my urocare legbags or my usual 4 nightbags/month. it's not a good situation and i'm still fighting.
    Cass, do you have back up insurance from your previous employer who will pay the rest? I have BC/BS as secondary and I'll fill out the Medicare forms if back up will pay their 80%. Beats paying for everything. Everything else prescription wise I have well covered but this stuff gets expensive.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  7. #17
    Quote Originally Posted by Sue Pendleton View Post
    Cass, do you have back up insurance from your previous employer who will pay the rest? I have BC/BS as secondary and I'll fill out the Medicare forms if back up will pay their 80%. Beats paying for everything. Everything else prescription wise I have well covered but this stuff gets expensive.
    i have supplemental thru boeing but it doesn't help if medicare denies. it only pays the % not paid by medicare approved stuff. the supplemental insurance does not pay for what medicare has denied. it does pay my scripts so i don't need medicare part D.

    it really is not an encouraging situation for me so far. i pay for medicare A,B (deducted from my SSDI, maybe $130), i pay for my boeing supplemental around $300 or so. not a pretty picture. AND my LTD from boeing ends in 6 yrs.

  8. #18
    Medicare does not require a 20% payment but they will only pay 80%. I use a company (Heartline Medical) and they wave the 20%. I get 150 catheters, 150 incontinent pads, a box of gloves, a tube of surgilube, a legbag and a bottle of colostomy freshener with no copay.

    I hope this helps.
    Millard
    ''Life's tough... it's even tougher if you're stupid!'' -- John Wayne


  9. #19
    Super Moderator Sue Pendleton's Avatar
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    DD, anything on what the going rate or no-rate is on foleys, etc in Madison, WI on Medicare?

    Cass, we have TRICARE that covers drugs instead of Part D.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  10. #20


    I sent in the waiver form. I already live with parents and just get by paying for all this other stuff that goes with my injury, plus school.

    If they don't accept, I will try another place.

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