Wheelchair covered?

[dimeolas]

Dad needs a wheelchair. Doctor send over documentation to the med supply store they use. Guy there says medicare doesnt cover DME. Talk to lady at doctors office and she says medicare doesnt cover DME. I read on the Medicare website they do cover DME. He has medicare as a primary and United health as secondary. The guy told me in the case of DME Medicare isnt the primary but his secondary...United..becomes the primary. And then he says out of network. United says there is no out of network for dads plan sincxe hes a retiree.
Sooo, I know theres a deductable so he will end up paying for the chair but the amount should go to burning off his deductible. But wanted to ask. Does medicare B pay for DME...aka...a wheelchair?
I'm assuming the store doesnt take United. Surely they use Medicare but whats up with the store and the docs office passing bad info ya think.
United suggested three companies in the area and will go thru them.
Thank you

 

[MBSC]

Yes, Medicare covers wheelchairs when medically necessary. In the past, there was a lot of fraudulent Medicare claims submitted for DME so now Medicare requires the DME supplier to complete a lot of paperwork. It sounds like that particular DME supplier doesn't want to deal with the Medicare paperwork. I'm glad to hear United was able to find other DME suppliers.

Wheelchairs & scooters
Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters) and manual wheelchairs as durable medical equipment (DME) that your doctor prescribes for use in your home. Power wheelchairs are covered only when they're medically necessary.

It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment. If suppliers don't accept assignment, there’s no limit on the amount they can charge you.

More information: https://www.medicare.gov/coverage/wheelchairs-scooters

 

[dimeolas]

Thank you. I wonder why the supplier just didnt say that and why the doctor's office referred me there and why they lied to me. Shows me for the future who I can't trust.
One last question(s)....as I understand it medicare works for a basic wheelchair, nothing fancy. Is there a deductable....I didn't see a mention of it and TBH don't know much about Medicare yet.
And last question. If worst come to worst can I file the claim myself. IE...Dad pays for a basic chair and I send in the forms and a doctors note and they reimburse him?
Thanks again.

 

[MBSC]

The Medicare Part B deductible of $198 (2020) applies to DME. The United health secondary plan may cover the deductible, it depends on what type of secondary plan it is.

Medicare has seen a lot of fraudulent claims regarding DME so they have become very particular about how those claims are submitted. You want to find a DME supplier that accepts Medicare assignment so the supplier will submit the claim and documentation for you.