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Thread: Paperwork : So much much back and forth - just for a cushion

  1. #1
    Senior Member NW-Will's Avatar
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    Paperwork : So much much back and forth - just for a cushion

    Naivety on my part maybe!

    Never really tracked the process before.

    1: Get a prescription from your doctor to see the PT seating specialist for a cushion.
    2: See PT seating specialist numerous times to figure which cushion works for you. took 3 90 minute appointments + demo's (first pt appointment 1st Nov 2018)
    3: See DME with PT seating specialist to order cushion.
    4: DME has to get LMN(Letter of medical necessity from PT)
    5: DME has to get prescription from Doctor.
    6: Doctor has to sign final forms for DME. - whatever these are ? (waiting on this)

    to be continued............

  2. #2
    Now imagine a similar process except you have the pleasure of paying out of pocket every time you see the PT or the doctor...

  3. #3
    Senior Member NW-Will's Avatar
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    Ridiculous... they are literally killing us with paperwork attrition.
    I learnt today that each stage has to be completed within a certain time frame or the paper work becomes invalid and has to be re-done, re-signed etc.



    Quote Originally Posted by funklab View Post
    Now imagine a similar process except you have the pleasure of paying out of pocket every time you see the PT or the doctor...

  4. #4
    I started my new chair and new cushion process in Feb 2018. It is now July 2019 and I JUST got my cushion (got my chair in April 19). I got a RIDE cushion and it was so terribly too high for me that it had to be altered. They basically just shaved off the bottom and that took nearly 4 months to get done. The time suck and the co-pays for every visit and measurement have broken me. Thankfully, all worked out in the end but it should never take this long to get new equipment. I'm a post-flap patient (2 years ) so it wasn't a good gamble for me to be on an old and defunct cushion all this time. I hope your case gets sorted quickly, I'll send some positive energy your way!

  5. #5
    No matter where we are, what health system there is, everyone is clipping the ticket.
    Example: this is a while back when I required a new cushion. Numerous letters back and forth between my OT and the health supply provider ( another private agency contracted to the Health Department). We worked out a moderate hourly calculation, including my time. to arrive at an estimated cost for the communication; it was near $1000. For a decent cushion that cost less than the time/paperwork necessary to arrive at a satisfactory conclusion.
    So, regardless if it is insurance, ACC or whatever health system in place, every effective dollar becomes pennies before we arrive at a conclusion.
    An economist could possibly point out the benefits of squandering money like that.
    I know that my budget cannot sustain such waste.

    Quote Originally Posted by funklab View Post
    Now imagine a similar process except you have the pleasure of paying out of pocket every time you see the PT or the doctor...
    Either way, you pay as an individual or we all pay collectively by increased premiums and taxes. It is the bloated inefficiency/gravy train/ticket clicking that kills it for most.
    Last edited by slow_runner; 07-18-2019 at 05:35 PM.

  6. #6
    Senior Member Oddity's Avatar
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    Other than waiting my process was transparent to me. Using Medicare, I don't need referrals to specialists, I just go. One meeting with OT/ATP and DME, they managed all the paperwork behind the scenes with the my D.O., one follow up meeting to tweak specs after initial CAD and prior authorization changes needed from Medicare, and after 10 months the chair, cushion, backrest, and smart drive showed up at my door, delivered by DME. Other than the wait and the round of prior auth denials for stuff (like the titanium) the process was really easy on my part. Tycon Medical in Tidewater VA area.
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  7. #7
    Senior Member NW-Will's Avatar
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    My first medicare/mediaid chair/cushion, when I was in Seattle, pretty much mirrored your experience, folks just did their job, not saying Seattle is anything great, but in comparison. Now I am really jealous of your experience.
    The amount of work I've had to do for this cushion alone is just beyond ridiculous, you would think I was in a different country. The expectations of folks here is so low, I really don't get it.

    If I ever get a new chair, I'll be sure to make the effort and travel up to Seattle for the next chair.


    Quote Originally Posted by Oddity View Post
    Other than waiting my process was transparent to me. Using Medicare, I don't need referrals to specialists, I just go. One meeting with OT/ATP and DME, they managed all the paperwork behind the scenes with the my D.O., one follow up meeting to tweak specs after initial CAD and prior authorization changes needed from Medicare, and after 10 months the chair, cushion, backrest, and smart drive showed up at my door, delivered by DME. Other than the wait and the round of prior auth denials for stuff (like the titanium) the process was really easy on my part. Tycon Medical in Tidewater VA area.

  8. #8
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    Guess I was lucky when my Roho went bad (3 yrs old). 1 trip to PT, requested same cushion, they (PT/DME) did an eval. A few weeks later, my cushion was shipped to my door. My daughter put the cover on it for me. Supplier was Numotion. Maybe the DME and hospitals relationship might have had an impact. Also, maybe that I didn't need a special contour.
    Medicare paper work showed retail was over $1000 (cushion only), Medicare allowed $350 (same price as Ebay and other sources).
    Medicare will allow a new cushion every 2 years. I won't wait till it goes bad next time.

  9. #9
    If I'm in desperate need of a new cushion (torn seam on my J2/leaking goo), I find the quickest way is to pay out-of-pocket and get a replacement from Sport-Aid. NuMotion charged my insurance something like 3x over the retail price so my 20% co-pay from insurance wasn't that far off from what I paid at SportAid. And I didn't have to wait 6+ months to get it.
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  10. #10
    Senior Member Oddity's Avatar
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    This is either the worst insurance ever, you've got your facts mixed up, or you're being scammed. 20% of whatever a DME wants to charge isn't a benefit worth paying for.

    (edit: The Medicare allowable amount for a new skin protecting cushion (Roho, Stimulite, etc. HCPCS E2624) is $331.37 in my region. It varies across the country but it's between ~$250-350 everywhere. Our 20% copay is ONLY 20% of this allowable charge, not 20% of whatever the DME wants to bill. ~$66 is all we should pay.)


    Quote Originally Posted by rshadd View Post
    If I'm in desperate need of a new cushion (torn seam on my J2/leaking goo), I find the quickest way is to pay out-of-pocket and get a replacement from Sport-Aid. NuMotion charged my insurance something like 3x over the retail price so my 20% co-pay from insurance wasn't that far off from what I paid at SportAid. And I didn't have to wait 6+ months to get it.
    Last edited by Oddity; 07-19-2019 at 08:46 AM.
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    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

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