In October, Medicare beneficiary David P. (not his real name), was shocked to see a charge of more than $1,000 on his credit card statement. The charge was for the complete cost of renting a machine he needed to help him recover from knee replacement surgery. The equipment is covered by Medicare, so Mr. P. thought he would be responsible only for his 20 percent co-payment.
But it turns out that the equipment supplier who rented him the machine never informed him that it is not a registered Medicare provider and that therefore Mr. P. may be responsible for the full cost of the rental.
"It is a problem that beneficiaries often do not know that they are using a non-participating supplier," says Alfred J. Chiplin, Senior Policy Attorney at the Center for Medicare Advocacy and co-author of The Medicare Handbook (Wolters Kluwer).
The good news is that Chiplin says a new Medicare program that has been launched in a few areas of the country will keep people like Mr. P. from unwittingly being liable for the full cost of such "durable medical equipment (DME)," which includes oxygen equipment, wheelchairs, walkers, and similar devices.
In the few areas of the country with the new program, which is called the “Medicare DMEPOS Competitive Bidding Program,” Medicare beneficiaries who expect any reimbursement may rent or buy certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) only from suppliers who contract with Medicare. In addition, non-contracting suppliers are required to tell Medicare beneficiaries that they don't work with Medicare and the beneficiaries must sign a waiver form stating they are aware of this. If the supplier fails to do this, the beneficiary is not liable for the charge.
Chiplin told ElderLawAnswers that equipment suppliers in the DMEPOS program areas are getting better at providing Medicare beneficiaries with the required notice that they are not contracting providers, and he says Medicare is stepping up its fraud and sanctions activity. (For more on the DMEPOS program, click here. To see if your zip code is in a coverage area, click here.)
Seek Medicare Reimbursement Anyway
But in the vast majority of the country not currently covered by the DMEPOS program, it is unclear whether suppliers who don't work with Medicare are under any obligation to alert Medicare beneficiaries of this fact. The best defense, then, is for beneficiaries to always make certain the supplier has a relationship with Medicare – something Mr. P. had no idea he should do.
If you are caught in the situation Mr. P. found himself in, you can submit your bill from the supplier and seek as much reimbursement as you can get, Chiplin says. (Mr. P. is still awaiting word from Medicare.)
"Once the DMEPOS program is fully implemented, beneficiaries should experience a greater reduction in DME out-of-pocket expenses as they will be required to use certified and registered DMEPOS providers in order to obtain Medicare-covered items," Chiplin says.
"It’s always best for beneficiaries to use certified suppliers and those who are Medicare participating suppliers," Chiplin counsels.