Greetings!

I plan on submitting a "Patient Request for Medical Payment form (CMS-1490S)" for some HEELMEDIX Heel Protectors I bought from Amazon.com a few weeks ago. This is my first time ever doing this so I am concerned and worried about how I should word this. A lying and shady 'foot doctor" had told me that he would get me some very good heel protectors and also handle the Medicare paper work. Instead, this charlatan didn't follow through on his word and bought back some worthless and ineffective Foam Liners.

Anyway, here's how I worded the form so far:
"Patient has quadriplegia via a spinal cord injury [C5-6, ASIA A] that was sustained several years ago and is non ambulatory as a result. Due to these complications, patient is prone to getting pressure ulcers on the heel's of his foot. Effective pressure relief helps prevent such skin breakdown, and heel protector devices that has "offloading" features (and also counter measures that are designed to prevent 'foot drop') are necessary: Which is why the "HEELMEDIX Heel Protectors" [HCPCS Code: E0191] are deemed appropriate and is the subject of this reimbursement request.

The supplier of the aforementioned heel protectors is unable to file a claim for those Medicare-covered DME items/s, so the patient is submitting this claim on his own behalf."



Is this wording sufficient or needs to be changed/edited? If so, then what changes need to be made and how would you word it? Thanks a bunch!