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Thread: New bed, and how to get insurance to pay for it?

  1. #1

    New bed, and how to get insurance to pay for it?

    Hi,

    My apologies if this is the wrong forum!

    My son (6'1" 180#, C6) has the worst POS bed. It's a Drive bed. They replaced the leaky low air loss mattress twice and the new one now only works if left on stagnant mode. The mattress whines and whistles all the time.

    The frame has twice come apart and crashed to the floor with him in it. It now has to be used fixed height, making it very hard to do transfers. His DME won't make any repairs because it's now over 2 years old (just). We paid a $200 co-pay for this thing and I feel sorely used.

    I know there are better beds that I can ill afford. I ogle beds on ebay but am terrified of getting stuck with something I cannot afford to fix. Are you all just able to buy your own beds, or is insurance paying?

    He has Medicare/Medicaid, and me.

    Any advice is sincerely appreciated.

  2. #2
    My sister's hospital bed was done through Medicare/insurance, not sure what the copay was, now I think it's 20%. We had one of those arrangements where after a year or so it was ours. My advice would be to find the bed you want and then contact your son's doctor and ask if they will write a prescription for it. Since Obamacare kicked in, most DME places won't work with you if you don't have a prescription. Medicare.gov is a good place to find what is and isn't covered. Good luck!

  3. #3
    Sounds like this was new when you bought it? Or was it used? Ask DME.
    If new and it's only 2 years old, I suggest you call Drive Medical yourself to discuss this issue and indicate DME is not helpful. Bed frame should not fall apart. Who put bed together in your home? DME?
    Some big medical items are paid for by Medicare on a rental basis. In this case, I believe the person owns it after the one year period. I have a cough assist device that was done like that.
    Find out from DME if this was a rental paid for by Medicare and you now own it. If Medicare, you should have received the standard Medicare statement explaining billing arrangement. In my case, I received monthly statements from Medicare. When one year was up, sure enough, no more payments, and I own it.

  4. #4
    Also, keep in mind that the mattress and the bed frame will be seen as two separate pieces of equipment under Medicare. The bed frame information above is correct. Medicare though will not pay for even rental of a LAL mattress unless your son has a current stage III or IV pressure ulcer. They will not pay for it under a preventive justification.

    (KLD)

  5. #5
    1. Go to https://www.medicare.gov/SupplierDirectory/
    Enter your Zip code and then check off "Hospital Beds and Related Accessories" under the heading "Competitive Bid Categories". This will give you a list of suppliers in your area who are approved Medicare contractors. If Medicare approves the bed, the most the Medicare approved DME can charge you out of pocket is 20% of the allowable cost.

    2. Your son will need to have had a face-to face with his doctor within 6 months of the date of the semi-electric bed prescription. The Rx has to be signed by the Physician even if the evaluation was done by a P.A. or N.P.

    Supporting medical records have to be submitted along with the Rx. Clear documentation of your son's diagnosis and medical condition, and an explanation of why the medical bed is necessary to treat your son's condition.

    The requirements are that the your son's medical condition requires body positioning not possible in an ordinary bed due to any of the following:
    1) Alleviating pain
    2) Needing his head to be elevated more than 30 degrees due to CHF/chronic pulmonary disease and /or aspiration
    3) Requiring traction equipment that can only be attached to a hospital bed
    4) Your son requires frequent and/or immediate changes in body position.

    This information, if document correctly, will mirror the official language used in the Medicare coverage guidelines for semi-electric hospital beds:
    https://www.cms.gov/medicare-coverag...=AAAAQAAAAAAA&

    This link should explain the Medicare competitive bidding process and the rental vs owner difference.

    https://www.medicare.gov/coverage/hospital-beds.html

    Last edited by 2drwhofans; 09-12-2015 at 10:17 AM.

  6. #6
    This is probably why your DME doesn't want to do the repairs after two years:

    Does Medicare pay or reimburse for hospital beds?

    Medicare considers hospital beds as a "capped rental" item. This means that Medicare will rent the bed for 13 monthly payments after which it will "cap out" and the beneficiary will own the bed. Medicare does not consider a full-electric hospital bed, deluxe bed, or a luxury bed to be medically necessary. If your physician feels a hospital bed is medically necessary, they must chart in the patient notes that they feel it is necessary and the reason why it is necessary verses a traditional bed.

    What does capped rental mean?

    Medicare will pay for the rental of the equipment for 13 continuous months of use with the exclusion of oxygen equipment which rents for 36 months. After Medicare has paid for 13 months of continuous use on capped rental equipment, the supplier shall transfer the title to the beneficiary.


    As Triumph suggested- contact Drive Medical Customer Service. Tell them the model / serial number and ask if it's covered.



    Warranty Information for theSemi-Electric Bed

    Drive Medical Limited Lifetime Homecare Bed Warranty:

    Limited Lifetime: Welds and Frame

    5 Years: Motor and Hand Control

    1 Year: All Other Parts and Components


    Last edited by 2drwhofans; 09-12-2015 at 02:23 PM.

  7. #7
    Thanks for the info and advice. I believe it was a Medicare rental that transferred to ownership. The dme assembled the frame. I will try contacting Drive and see if I can get any help there. The dme says we own it now, and they won't touch it.

    At the time he got the LAL he did have a wound (he had recently been discharged from SNF), and unfortunately has one on his outside of his foot right now.

    I just can't believe the dme is even permitted to rent such a POS to a long term user. I played around with the bed frame to see why it was coming apart -- if it's lowered onto anything, a pillow, empty box, no matter how slight the resistance, the frame pops apart and the axel falls out.

  8. #8
    Drive should cover the bed according to this! Thanks!

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