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Thread: New to Medicare. Question about catheters

  1. #1
    Senior Member tarheelandy's Avatar
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    New to Medicare. Question about catheters

    I just got approved for Medicare. I have been buying my own catheters from Express Medical for 5 yrs. I am thinking that Medicare will now pay for them but I can't find on their website how to get them from a supplier. There is no one locally that has them. I tried looking up DME on the website, but no luck. Those who do order theirs, how do you find a supplier?

    Thanks,

    Andy

  2. #2
    i use ccs medical, get a drs script for them, then you send it to them, every month i get an email to confim my order, and they arrive, medicare doesnt cover 100%.. i end up paying about $15 a month( i get 30 condom caths, then leg bag/night bag when needed)
    - Rolling Thru Life -

  3. #3
    Senior Member tarheelandy's Avatar
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    Okay, so how do you know if they are a Medicare supplier? Say I want to keep using Express Medical.....

  4. #4
    tarheelandy

    Follow the path of the other Andy.

    http://sci.rutgers.edu/forum/showthr...ht=uti+medical

  5. #5
    Senior Member tarheelandy's Avatar
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    Thanks.....

  6. #6
    Express Medical has a subsidiary set up to handle Medicare covered urological supplies including catheters. I have been buying my ostomy supplies from them for years. They have provided excellent service. Call them and they will guide you through the process.

    http://www.dukemedicalsupply.com/dept.asp?dept_id=830
    You will find a guide to preserving shoulder function @
    http://www.rstce.pitt.edu/RSTCE_Reso...imb_Injury.pdf

    See my personal webpage @
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  7. #7
    There are several important things to know about Medicare coverage for monthly supplies like those for urologic purposes.
    1. Find a medical supplier that will file your claim with Medicare for you. Don't use a supplier that sends you the paper work and expects you to file with Medicare.
    2. Make sure that any supplier you use has a PTAN (Provider Transaction Access Number). Anytime you contact a medical supply company, make sure they can provide you with this number. If they can't, they aren't Medicare recognized, approved, acknowledged and you won't get to square one with Medicare on an appeal if your supplier doesn't have this number.
    3. Your physician must write the prescription for you supplies according to Medicare regulations. Make sure your physician understands your needs and how to prescribe for Medicare coverage. An Rx from your doctor is the first step in dealing with any medical supply company for urologic supplies. If the Rx isn't written correctly you will have problems making claims. Your doctor must provide clinical notes about your need for the supplies you require and why you require these supplies.
    4. You can go to Medicare.gov to check if suppliers are Medicare approved suppliers. You will need the zip code of the location of the supplier to check their eligibility at this site.

    Remember, Medicare will only cover 80% of the costs, if you don't qualify for Medicare supplement coverage, you will be responsible for the balance.

    All the best,
    GJ

  8. #8
    Senior Member tarheelandy's Avatar
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    Very, very helpful info from all of you. I will call Express Medical first and try that, since I have always loved their service. I guess I will sign up for a supplemental plan as that seems the way to go. I have gone through the Medicare website and it is overwhelming, to say the least! May have more questions later.....

  9. #9
    Quote Originally Posted by tarheelandy View Post
    Very, very helpful info from all of you. I will call Express Medical first and try that, since I have always loved their service. I guess I will sign up for a supplemental plan as that seems the way to go. I have gone through the Medicare website and it is overwhelming, to say the least! May have more questions later.....
    Indeed the Medicare website is a behemoth!!! I can walk you through how to check to see if a supplier you are considering is an approved supplier.

    1. Go to: http://www.medicare.gov/
    2. Scroll to the bottom of the page
    3. Find the column labeled "Take Action"
    4. Scroll down 3 items to "Where can I get covered medical items?" Click
    5. Enter the zip code of the supplier you are considering. Express Medical Supply is in Fenton, MO 63026. Submit
    6. Scroll down the second column on this page that begins with "Mobility Devices." The second to the last item is "Urological Supplies." Check that box.
    Select "View Results."
    7. You will get a list of suppliers. In that zip code, there are 6 suppliers at 9 locations
    Express Medical Supplier is not listed. Certainly, the list may not be fully up to date, but I have found they are pretty current.

    APRIA HEALTHCARE INC is the only supplier labeled Participating, that means:
    Suppliers that participate in Medicare. Participating suppliers must accept assignment for all supply categories (accept Medicare's approved payment amount as payment in full-80%, your supplement would pay 20%). This supplier will bill Medicare for you. Always ask if the supplier has a PTAN ((Provider Transaction Access Number).
    Note: You may pay more for products and supplies from suppliers that do not accept Medicare's approved payment amount as payment in full.

    These other suppliers may or may not bill Medicare for you. You will have to ask (Note that Duke Medical Supply mentioned by "SCI55" is listed) whether these suppliers will bill Medicare for you. You will have to ask if they will accept the Medicare approved rates (assignment). If not, you may have to pay up to 115% more than the Medicare approved rates.

    CARE MEDICAL SUPPLIES INC

    DUKE MEDICAL SUPPLY, INC

    ST. LOUIS MEDICAL SUPPLY, INC

    SV PHARMACIES INC

    WALGREEN CO (3 locations)

    Hope this helps to guide you through at least one maze.

    All the best,
    GJ
    Last edited by gjnl; 02-06-2013 at 03:14 PM.

  10. #10
    Senior Member DaleB's Avatar
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    You aren't restricted to using local participating provider for Uro supplies.

    I picked the one willing to wave the Medicare self-pay portion, after a brief negotiation, after trying several.

    180Medical
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