PATIENT RESOURCES

Frequently Asked Questions

A Dispensing Order written by the treating physician must be sent to us before an item can be supplied. Some items require a Detailed Written Order (DWO) prior to delivery or a Certificate of Medical Necessity (CMN).

A Dispensing Order (prescription) must include:

  • A description of the item
  • The beneficiary’s full name
  • The date of order
  • Physician’s signature and date

 

A Written Order must include:

  • Detailed description of the item and accessories
  • The beneficiary’s full name
  • An ICD-9-CM diagnosis code
  • Start date of the order
  • The length of need
  • Physician’s signature and date

Medicare Part B helps pay for durable medical equipment, including:

  • manual wheelchairs (capped rental item)
  • power wheelchairs
  • nebulizers (capped rental item)
  • walkers, rollators, canes, crutches
  • scooters (POV’s)
  • seat-lift mechanisms for lift-chairs
  • mattress over-lays (capped rental item)
  • hospital beds, semi-electric type only (capped rental item)
  • patient lifts (capped rental item)
  • CPAP & BiPAP therapy
  • oxygen equipment (capped rental item)

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. Oxygen equipment does not transfer title to the beneficiary and the supplier is required to maintain the equipment until the 60th month under Medicare guidelines. After the 60th month the beneficiary can opt for new equipment and a new 36 month rental period begins.

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.

Medicare considers wheelchairs as a “capped rental” item. This means that Medicare will rent the wheelchair for 13 monthly payments after which it will “cap out” and the beneficiary will own the wheelchair. Medicare does not consider a lightweight, ultra-lightweight, heavy duty, or modified chair medically necessary without doctors notes that support the medical need for such add-ons. If your physician feels a wheelchair 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 cane, walker or crutch.

A power wheelchair may be covered when all of the following criteria are met:

  • The patient’s condition is such that without the use of a wheelchair the patient would otherwise be bed or chair confined.
  • The patient’s condition is such that a wheelchair is medically necessary and the patient is unable to operate a scooter(POV), wheelchair, walker, cane or crutch in their home.
  • The patient is capable of safely operating the controls for the power wheelchair.

Insurance We Accept

  • ABSOLUTE TOTAL CARE
  • ABSOLUTE TOTAL CARE (ALWELL)
  • ABSOLUTE TOTAL CARE (AMBETTER)
  • ABSOLUTE TOTAL CARE (MEDICARE/MEDICAID HEALTHY CONNECTIONS)
  • ADVANTRA
  • AETNA
  • ALLIANCE HEALTHCARE
  • BLUE CROSS/BLUE SHEILD OF SOUTH CAROLINA (ALL PLANS)
  • BLUE CROSS/BLUE SHEILD STATE HEALTH PLAN
  • BLUE CROSS/BLUE SHEID FEDERAL
  • BLUE CHOICE HEALTH PLAN OF SOUTH CAROLINA
  • HEALTHY BLUE (BLUE CHOICE) HEALTH PLAN
  • CARE CENTRIX
  • FIRST CHOICE HEALTH PPO NETWORK
  • GEHA
  • HOMELINK
  • hUMANA
  • HUMAN CHOICE CARE NETWORK
  • HUMANA CHOICE CARE PPO
  • HUMANA CHOICE CARE POS
  • HUMANA CHOICE CARE HMO
  • HUMANA GOLD CHOICE
  • HUMANA GOLD PLUS
  • MEDICARE
  • MEDICAID OF SOUTH CAROLINA
  • MOLINA HEALTHCARE OF SOUTH CAROLINA
  • SELECT HEALTH OF SOUTH CAROLINA
  • SELECT HEALTH OF SOUTH CAROLINA (1ST VIP CHOICE CARE PLUS)
  • TRICARE EAST
  • UNITED HEALTHCARE CHOICE
  • UNITED HEALTHCARE CHOICE PLUS
  • UNITED HEALTHCARE OPTIONS PPO
  • WINDSOR HEALTH PLAN OF SOUTH CAROLINA
  • CIGNA HMO
  • PLANNED ADMINISTRATORS
  • WELLCARE OF SOUTH CAROLINA

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