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Medicare and Private Insurance

When it comes to Medicare or health insurance for your durable medical supply needs, it is important to understand the way billing works. The first thing you should know is that Budget Medical Supplies does not bill Medicare or any other insurance company you may have directly. Rather what we do is follow a set of steps that allows you to receive up to 80% back on certain products (the qualifications for this are listed below).

It is important to realize that this does not mean you will definitely get a reimbursement approval for your purchase on the durable medical goods. You will need to contact Medicare or your other insurance company to understand their requirements for your purchases.

If the purchase you are making is eligible for a reimbursement you will need to supply a few pieces of information to either Medicare or your insurance. This include:

  • A prescription from your doctor for the item you purchased
  • The proof of delivery- this can be a packing slip or shipping receipt or similar documentation
  • Form 1490- this is only required in certain situations, specifically with Medicare

What Products are Eligible for Reimbursement? 
The rules regarding reimbursement are different with each product. You will want to look at the guidelines below on these products to understand if they qualify for a reimbursement with Medicare. If you have another insurance provider you will need to speak with them to determine what their eligibility requirements are.

Qualifying for Reimbursement on Power Wheelchairs and Mobility Scooters
In order to get reimbursed for a power wheelchair or mobility scooter, you will need to meet the following criteria:

  • You must have limitations in your mobility that make daily living activities such as bathing, dressing and eating on your own difficult or impossible.
  • Your condition that you are using as the means for the mobility device must be the sole reason for your limitations. This means you cannot have mobility issues because of a condition and because of vision impairment and claim this as a reason to need a mobility device. There is an exception to this: If your caregiver can address one of the conditions.
  • You will need to be able to show that having the mobility device will be essential to helping you perform one or more daily living activities in a way that you currently cannot.
  • You must also show that basic mobility devices such as a cane or a walker simply will not be enough to overcome the limitations you are dealing with in your mobility.
  • You will need to be able to show that you can use the device safely. This means showing that you have teh necessary stability and strength in your core muscles to sit upright and operate the mobility device during the day.
  • You will also need to show that you will be able to use the mobility device in your day to day life. This means that you can get around your home with the scooter without any problems, such as insufficient space.

Qualifying for Reimbursement on Lift Chairs
You will need to meet the following qualifications to receive a reimbursement on a lift chair:

  • You must have a debilitating condition such as major arthritis in the hip or knee or severe neuromuscular disease that affects your ability to get up.
  • You must not be able to get to a standing position on your own when you are in a normal armchair in your home. Keep in mind that if you only have difficulty getting in and out of the chair, then this does not qualify under Medicare. This particularly applies to low chairs where you may be able to get out if the seat of the chair was raised higher. This is designed specifically for people who cannot get out of even a raised chair on their once.
  • The other requirement is that you must have the ability to walk once you are out of the chair to qualify.

You should note that even if Medicare approves you for reimbursement that they would only cover the mechanisms that make the chair lift. This is generally up $300 though it may differ depending on where you live, so make sure you understand the full reimbursement price for your area. Also, keep in mind that the doctor that writes the prescription for the lift chair must also be your attending physician and not just some doctor you see occasionally.

Qualifying for Reimbursement on Bathroom Safety Aids
While bathroom safety aids are an essential tool for many people, this is not something that Medicare covers at this time.