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Thread: Medicare supplement copayment?

  1. #31
    Quote Originally Posted by darkeyed_daisy View Post
    Every state has different insurance companies that handles Medicare's millions of claims. Medicare does not handle its own insurance....it contracts it out to other insurance companies. I don't know the answer to that. It is beauracracy at it's finest. I believe it is noridian that handles yours in Washington while Palmetto GBA handles South Carolina and North Carolina's.

    I hope the answer above helped...if not let me know and I will dig further. I bet your DME is billing the wrong codes to Medicare. Your insurance at Boeing probably didn't care all those years and just paid the additional amounts without question but Medicare is going to ask for justification
    so, even though the denial letters state medicare denial, they are coming from noridian directly? that is the return address. and there are no fed standards for a fed program? i can't appeal to medicare, bypassing noridian?

  2. #32
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    Medicare Contractors

    Medicare contracts administration of the Durable Medical Equipment (DME) program to 4 regional carriers, referred to as DME MACs (or DMAC).

    Here is the link to the DMAC for the Northeast - http://www.medicarenhic.com/dme/index.shtml

    You will find on the home page information on fee schedules, coverage policies, etc.

    Each of the other 3 carriers would have similar websites that you can access.

    So bottom line, if you have a question about Medicare coverage, payment, etc. and you want to contact "Medicare" to find an answer, you would go through the DMAC responsible for the state in which you reside.

  3. #33
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    Map for DME MAC's (and contact information)


  4. #34
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    Quote Originally Posted by cass View Post
    so, even though the denial letters state medicare denial, they are coming from noridian directly? that is the return address. and there are no fed standards for a fed program? i can't appeal to medicare, bypassing noridian?
    You appeal to Medicare. It is a federal program but it is contracted out and handled by Noridian. You follow the appeals process that it outlines in your letters. Noridian has to follow their guidelines and they can differ from state to state.

    I hope that makes sense
    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. #35
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    Cass

    As Tom pointed out there are four different Fiscal Intermediary's or insurance companies handling DME claims. They all have to go by the same federal guidelines which are the Local Coverage Determinations.

    It is complicated....but the federal guidelines are the National and Local Coverage Determinations which are Medicare rules.

    I would talk to your DME about the billing before I filed an appeal if I were you.

    If you are going to appeal, you only have so many days to file. It tells you on the letter. If you have been getting supplies for three or four months then you have probably run out of time to appeal. It is usually 120 days.

    Of course, you can do both. If it is a billing error on the DME's part, it will not do you any good to appeal.

    You can also call the number on the denial letter and ask them why it was denied. Sometimes they will be helpful and tell you "it is a billing error or your physician did not specify a diagnosis" and sometimes they won't" Sometimes the representative on the other end just doesn't know enough to tell you one way or the other.
    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. #36
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    I stand corrected....it used to be palmetto GBA but now it looks like Cigna handles nc/sc medicare DME claims. It looks like lots of things have changed since I left the NC hospital system.

    Thank you Tom. That is excellent information and I have bookmarked for future reference.

    This would be helpful information for all of us to bookmark and keep handy.
    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

  7. #37
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    Cass

    Does it give you a reason for the denial? If it does, what is it?
    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

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