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Thread: My craziest Medicare experience yet

  1. #11
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    I have Medicare. No Medicaid. You want get titanium wheelchair and they flat out say "no." Why don't they have some type of "cap" limit and allow yout to simply pay 100% over the cap if you choose? I getting new chair and should be delivered anytime now, I told the place forget about insurance I will pay 100%. I did get them down to Internet price which really is the 80% Medicare would pay. I don't argue with them. Simply hope not to need them.

  2. #12
    Quote Originally Posted by cass View Post
    i can't get urocare leg bags out of them because "no one uses those"; hello? i have gotten them thru care medical for yrs when still able to work.
    Hi Cass.
    If you are having trouble getting Urocare leg bags from your supplier, Edgepark Medical Supplies maybe able to help you out via mail order (covered by Medicare and my secondary). I get mine there. Getting set up with Edgepark may take some time for them to get it right, especially if you use more leg bags than 2 per month. But, eventually, they do get it right and call and/or email monthly for your approval to send out the supplies.

    Quote Originally Posted by sledgrl View Post
    Insurance seems to get crazier and crazier with what they will & won't cover. I have BCBS through work and Medicaid, both cover DME and cath supplies at 100% (in theory). The company I was getting my S/P tube supplies from called to my insurance wouldnt pay for insertion kits because they aren't needed...what! They didn't take Medicaid either so they were going to bill me. Had to switch to company that also takes Medicaid.
    Hi "sledgrl,"
    We have never used an insertion kit for my suprapubic catheter (2+ years). NL changes my SP catheter every month. She lines a plastic shoe box lid with plastic food wrap film and lays out the changing supplies on that, i.e., povidone swabs, 10cc syringe filled with sterile water or saline, lubricated new catheter, emesis tray with gloves to place the removed catheter, sterile gloves for insertion of new catheter. I guess I never thought about trying to get these supplies paid for by Medicare. My company provided private insurance never paid for any intermittent catheter supplies other than the catheters (no lubricant, skin antiseptics etc.)


    All the best,
    GJ

  3. #13
    GJ-Smart idea for the SP insertion kit. We have not had trouble getting the kits, but very clever thinking on you and NL's part.
    We have all the components on hand for other things.

    My biggest surprise was when the powerchair needed some work and parts.
    We were told Medicare would not pay for repairs because the chair "did not exisit."
    I had very good private insurance at the time the chair was bought.
    When COBRA ran out I assumed medicare or medicaid would cover it.

    DME said medicare would buy a new chair (not that it is a simple snag free thing from what I read here) bit not repairs.
    They encouraged us to do this!

    Now the VA maintains the chair.

  4. #14
    Quote Originally Posted by LindaT View Post
    GJ
    My biggest surprise was when the powerchair needed some work and parts.
    We were told Medicare would not pay for repairs because the chair "did not exisit."
    I had very good private insurance at the time the chair was bought.
    When COBRA ran out I assumed medicare or medicaid would cover it.

    DME said medicare would buy a new chair (not that it is a simple snag free thing from what I read here) bit not repairs.
    They encouraged us to do this!

    Now the VA maintains the chair.
    This pre-existing chair (purchased before Medicare eligibility)/maintenance thing is an incredible puzzle. My private insurance purchased a power chair that was delivered in late 2009, about 6 months before I became age eligible for Medicare. Just a few weeks after joining Medicare in late middle of 2010, a stop (to limit how far back the arm would rotate) broke on one of the arms. I called the durable medical equipment supplier I use to get the repair. The wheelchair manufacturer would pay for the part under warrantee, but not the labor. I looked to Medicare and my supplemental insurance to pick up that up.

    Because my chair was less than a year old, my durable medical equipment supplier could record my chair into Medicare records. Medicare and my supplement picked up the labor for that repair. Now in late 2012, I need a new gear box and motor (I only need the gear box, but the manufacturer only supplies gear box and motor as a package replacement part) and new batteries. I visited my supplier last week and because my chair is in Medicare records (it exists), there is no problem with Medicare and my supplement picking up the repair. And, as has been discussed on threads before, this repair WILL NOT "start the clock running" as if this chair were brand new. Since Medicare will provide a new chair every 5 years, I was told by my supplier that I will be able to start the process of replacing this chair in early 2015.

    My supplier told me the key to getting Medicare to cover the repairs I have had was getting the chair in Medicare records before the chair was one year old, even though I was not a Medicare participant when the chair was purchased and Medicare did not provide the chair.

    Linda, very glad that VA connection you discovered paid off you and Dave.

    All the best,
    GJ

  5. #15
    Senior Member
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    Yes

    Quote Originally Posted by grommet View Post
    Nothing insurance can do to surprise me anymore. Years ago I wanted to replace the seatback fabric on my Jay2 Deep and Tall. The fabric was $40 but insurance wouldn't pay for it. They would however pay for a brand new Jay Deep and Tall seatback that comes with new seat fabric for $640. Yeah, okay. I gave up a long time ago on trying to make any sense out of it all.
    I not understand why they tell you go float on all of this stuff when not within thier guidelines. Why don't they have an intelligent cap system that pays no matter what and you/we just get stuck with remainder.

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